title: Morbidity and mortality of patients diagnosed with systemic sclerosis after the age of 75: a nested case-control study.
abstract: This study aims to characterize the clinical features of a cohort of patients diagnosed with systemic sclerosis (SSc) after the age of 75 and compare them to a group diagnosed at a younger age. We record the review of 769 patients diagnosed with SSc over the past 16 years. Utilizing a nested case-control model, we compare demographics, disease severity, morbidity, and mortality data of all patients diagnosed after the age of 75 to sex- and disease-type-matched, randomly selected group of patients diagnosed with SSc before the age of 60. Twelve patients were diagnosed with SSc after the age of 75, seven with the diffuse, and five with the limited form. It took longer to diagnose SSc in the older patients, and comparison of disease severity revealed a worse pulmonary picture and a more frequent development of malignancy in the older patients as compared with the younger ones. During a mean follow-up of 36.2 months, our cohort of patients did not have worsening in their disease severity, though 6 months after the last follow-up, six patients died. We conclude that a diagnosis of SSc at an older age appears to be a poor prognostic indicator related to both disease severity and comorbidities. A higher clinical suspicion will lead to an earlier diagnosis and a potential decrease in morbidity and mortality.
authors.affiliation: Department of Medicine, Division of Rheumatology, Thomas Jefferson University, Philadelphia, PA, 19017, USA. chris.derk@jefferson.edu
authors.forename: Chris T
authors.initials: CT
authors.lastname: Derk
authors.forename: Carol M
authors.initials: CM
authors.lastname: Artlett
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Jimenez
mesh_terms: D000368:Aged; D000375:Aging; D016022:Case-Control Studies; D015331:Cohort Studies; D003710:Demography; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D045743:Scleroderma, Diffuse / Q000453:epidemiology; D045745:Scleroderma, Limited / Q000453:epidemiology; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index