Lower Incidence of Severe Damage to Target Organs in Mexican Patients With Systemic Sclerosis and Diffuse Skin Affection

Rojas-Serrano, Jorge; Codina-Velásquez, Helga; Medrano-Ramírez, Gabriel; Abraham Simón, J.; Vera-Lastra, Olga; Vázquez-Mellado, Janitzia

doi:10.1016/S2173-5743(08)70142-4

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Objective

To determine the cumulative incidence of severe organ involvement in Mexican patients with systemic sclerosis (SS) and diffuse scleroderma at 3 years from the onset of SS symptoms, and to compare it with the cumulative incidence observed in a cohort of white patients with SS.

Patients and method

Patients with SS and diffuse scleroderma were evaluated within the first 2 years from the onset of SS symptoms and were included. An estimation of the cumulative incidence of severe involvement to the skin, kidney, heart, lungs, and gastrointestinal track at 3 years from the onset of SS symptoms was carried out. This cumulative incidence was compared with that of white SS patients with diffuse scleroderma, using the one sample test for a binomial proportion.

Results

Sixty-three patients were included. The cumulative incidence of severe involvement to the skin was 3.17% (2/63) (95% CI, 0.04–11); kidney involvement in 4.17% (3/63) (95% CI, 0.99–13.29); heart involvement in 1.6% (1/63) (95% CI, 0.04–8.5); lung involvement in 11.11% (7/63) (95% CI, 4.5–21.5); and gastrointestinal involvement in 4.7% (3/63) (95% CI, 0.99–13.3). Mexican patients had a lower incidence of severe skin involvement (P=.0001), kidney involvement (P=.03), and heart involvement (P=.03) compared to white SS patients with diffuse scleroderma.

Conclusions

The cumulative incidence of severe organ involvement in SS Mexican patients with diffuse scleroderma was determined. The incidence of severe skin, kidney, and heart involvement is lower than in white SS patients with diffuse scleroderma.

Key words:

Systemic sclerosis

Diffuse scleroderma

Ethnic differences in epidemiology

Clinical expression differences

Objetivo

Determinar la incidencia acumulada de daño grave en órganos diana en la esclerosis sistémica con afección cutánea difusa (ESD), en una cohorte de pacientes mexicanos a los 3 años desde el inicio de los síntomas de la enfermedad, y compararla con lo observado en una cohorte de pacientes blancos.

Pacientes y método

Se incluyó a los pacientes evaluados por primera vez en los primeros 2 años desde el inicio de los síntomas de la ESD. Se determinó la incidencia acumulada de daño grave en los siguientes órganos: piel, riñones, sistemas cardiovascular, pulmonar y gastrointestinal, y se comparó con lo observado en una cohorte donde el 94% de los pacientes son blancos, mediante la prueba de una muestra para una proporción binomial.

Resultados

Se encontró que 63 pacientes cumplían los criterios del estudio. La incidencia acumulada de daño grave en la piel fue del 3,17% (2/63) (intervalo de confianza [IC] del 95%, 0,04–11); daño renal del 4,17% (3/63) (IC del 95%, 0,99–13,29); daño cardiovascular del 1,6% (1/63) (IC del 95%, 0,04–8,5); daño pulmonar grave del 11,11% (7/63) (IC del 95%, 4,5–21,5), y daño gastrointestinal del 4,7% (3/63) (IC del 95%, 0,99–13,3). Al comparar los datos con los observados en pacientes blancos en el mismo período de evolución de la ESD, se encontró una menor incidencia de daño grave en la piel (p=0,0001), y daño renal (p=0,03) y cardiovascular (p=0,03).

Conclusiones

Se determinó la incidencia de daño grave en órganos diana en pacientes mexicanos con ESD a los 3 años desde el inicio de los síntomas. La incidencia de daño de piel, y daño renal y cardiovascular es menor que lo observado en pacientes de raza blanca.

Palabras clave:

Esclerosis sistémica

Esclerodermia difusa

Diferencias étnicas en epidemiología

Diferencias en la expresión clínica

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