title: Patients with Systemic Sclerosis/polymyositis Overlap Have a Worse Survival Rate Than Patients Without It.
abstract: Studies on mortality associated with patients with systemic sclerosis (SSc) and myopathy have been limited by heterogeneous definitions of muscle involvement. The objective of this study is to determine whether homogeneous-defined SSc/polymyositis overlap (SSc-PM overlap) is associated with a worse survival rate compared with SSc without PM.
  
  
  
  Data from the Nijmegen Systemic Sclerosis cohort were used. Incidence rates were calculated from the observed number of deaths and followup time. Survival analysis using Cox proportional hazard modeling was performed to compare survival among patients with SSc and patients with SSc-PM overlap, including controlling for confounders. All patients with SSc-PM fulfilled the Bohan and Peter criteria for PM.
  
  
  
  There were 24 patients with SSc-PM (5.7%) and 396 patients with SSc (94.2%). The 5- and 10-year cumulative survival rates from diagnosis were 82% and 68% for the SSc-PM group and 93% and 87% for the SSc group, respectively. Multivariate survival analysis revealed an adjusted HR of 2.34 (95% CI 1.09-5.02) for SSc-PM compared with SSc, with age at diagnosis, modified Rodnan skin score, diffuse cutaneous subtype, and male sex included as confounders. The most common cause of death among patients with SSc-PM overlap was cardiopulmonary involvement (63%), which was similar to the patients with SSc (51%).
  
  
  
  Patients with SSc-PM overlap have a worse survival rate compared with patients with SSc.
authors.affiliation: From the Department of Rheumatology, and Department of Quality of Health Care, and Department of Neurology, Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.K.J. Bhansing, MD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; P.L. van Riel, MD, PhD, Department of Quality of Health Care, Institute for Health Sciences, Radboud University Medical Center; B.G. van Engelen, MD, PhD, Department of Neurology, Institute for Health Sciences, Radboud University Medical Center; J. Fransen, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; M.C. Vonk, MD, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center.
authors.forename: Kavish J
authors.initials: KJ
authors.lastname: Bhansing
authors.affiliation: From the Department of Rheumatology, and Department of Quality of Health Care, and Department of Neurology, Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.K.J. Bhansing, MD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; P.L. van Riel, MD, PhD, Department of Quality of Health Care, Institute for Health Sciences, Radboud University Medical Center; B.G. van Engelen, MD, PhD, Department of Neurology, Institute for Health Sciences, Radboud University Medical Center; J. Fransen, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; M.C. Vonk, MD, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center.
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: From the Department of Rheumatology, and Department of Quality of Health Care, and Department of Neurology, Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.K.J. Bhansing, MD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; P.L. van Riel, MD, PhD, Department of Quality of Health Care, Institute for Health Sciences, Radboud University Medical Center; B.G. van Engelen, MD, PhD, Department of Neurology, Institute for Health Sciences, Radboud University Medical Center; J. Fransen, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; M.C. Vonk, MD, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center.
authors.forename: Baziel G M
authors.initials: BG
authors.lastname: van Engelen
authors.affiliation: From the Department of Rheumatology, and Department of Quality of Health Care, and Department of Neurology, Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.K.J. Bhansing, MD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; P.L. van Riel, MD, PhD, Department of Quality of Health Care, Institute for Health Sciences, Radboud University Medical Center; B.G. van Engelen, MD, PhD, Department of Neurology, Institute for Health Sciences, Radboud University Medical Center; J. Fransen, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; M.C. Vonk, MD, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center.
authors.forename: Jaap
authors.initials: J
authors.lastname: Fransen
authors.affiliation: From the Department of Rheumatology, and Department of Quality of Health Care, and Department of Neurology, Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.K.J. Bhansing, MD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; P.L. van Riel, MD, PhD, Department of Quality of Health Care, Institute for Health Sciences, Radboud University Medical Center; B.G. van Engelen, MD, PhD, Department of Neurology, Institute for Health Sciences, Radboud University Medical Center; J. Fransen, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center; M.C. Vonk, MD, PhD, Department of Rheumatology, Institute for Health Sciences, Radboud University Medical Center. Madelon.Vonk@radboudumc.nl.
authors.forename: Madelon C
authors.initials: MC
authors.lastname: Vonk
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017285:Polymyositis / Q000401:mortality*; D012595:Scleroderma, Systemic / Q000401:mortality*; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate
keywords: MUSCULAR DISEASES; MYOSITIS; POLYMYOSITIS; SURVIVAL ANALYSIS; SYSTEMIC SCLEROSIS