title: Effect of dihydropyridine calcium channel blockers and glucocorticoids on the prevention and development of scleroderma renal crisis in an Italian case series.
abstract: OBJECTIVE
  Scleroderma renal crisis (SRC) is a relative rare yet dramatic event in the history of systemic sclerosis (SSc). Several factors that may precipitate or protect from the development of SRC have been described in previous case-control studies. To date, no attempt has been made to evaluate these factors in an observational fashion.
  
  
  METHODS
  Retrospective data from 410 SSc patients with disease duration <5 years at referral were evaluated in an observational fashion for the development of hypertensive or normotensive SRC within 5 years from the first visit at our centre. Baseline characteristics as well as the use of steroids or dhiydropyridine calcium-channel blockers (CCB) were analysed via the Cox regression method with time-dependent covariates.
  
  
  RESULTS
  In the multivariate model the diffuse subset the disease (HR=5.728 CI(95)=2.199-14.918, p<0.001) and the use of prednisone (HR=1.015, CI(95)=1.004-1.026, p=0.006) resulted to be predictors for the development of SRC, with a risk to develop SRC increased by 1.5% for every mg of prednisone/day consumed the trimester prior SRC. Contrariwise, the risk to develop SRC was highly reduced in those who were prescribed CCBs (HR=0.094, CI(95)=0.038-0.236, p<0.001).
  
  
  CONCLUSIONS
  Steroids exhibits a weak effect on the risk to progress toward SRC in our case series, whilst dhyidrophyridines CCB appeared to be protective against that. Further larger prospective studies are warranted to better define the role of CCB in this setting or as a background therapy for SSc.
authors.affiliation: Referral Centre for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy. gaia_gaia85@hotmail.com
authors.forename: Gaia
authors.initials: G
authors.lastname: Montanelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Beretta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Santaniello
authors.forename: Raffaella
authors.initials: R
authors.lastname: Scorza
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D020746:Calcium Channels, L-Type / Q000378:metabolism*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D020746:Calcium Channels, L-Type; D005938:Glucocorticoids; D014665:Vasodilator Agents; D011239:Prednisolone; D016285:Iloprost