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. 2001 Dec;60(12):1117–1122. doi: 10.1136/ard.60.12.1117

Disease severity of 100 patients with systemic sclerosis over a period of 14 years: using a modified Medsger scale

A Geirsson 1, F Wollheim 1, A Akesson 1
PMCID: PMC1753441  PMID: 11709453

Abstract

OBJECTIVE—To assess organ involvement according to a modified Medsger severity scale and its relation to outcome and prognosis in patients with systemic sclerosis.
METHODS—One hundred consecutive patients observed in Lund with systemic sclerosis were followed up for a period of 14 years. The mean follow up time was 7.7 years. Initial assessment and an annual evaluation was performed for each patient, with a mean visit frequency of 5.6 per patient.
RESULTS—Age at referral, high total skin score, truncal skin involvement, low vital capacity, low static lung compliance, low Cr-EDTA clearance, and ECG abnormalities at the initial assessment predict poor outcome. A severity scoring system for five organ systems indicates a slow progression of organ dysfunction after recruitment into the study. The female: male ratio was 2:1, the mean age at onset of symptoms was 42.3 (range 3-82), and the mean age at recruitment was 47.2 years (range 17-82). Thirty patients died during the follow up period at the mean age of 61.3 years (range 33-85). The causes of death were directly related to systemic sclerosis in at least 10 patients, infections in six, cancers in nine, and other causes in four patients. The standardised mortality ratio was 3.5 and 3.7 for men and women, respectively.
CONCLUSION—A high severity score for function of vital organs was shown to predict shortened survival. In this study a severity score based on simple clinical assessment variables was able to predict poor outcome from extensive skin changes, ECG changes, and compromised lung and renal function. Organ dysfunction mainly became manifest during the first five years of the disease, whereafter organ function remained largely stable.



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Figure 1  .

Figure 1  

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Survival time in non-survivors. Within six years from recruitment into the study 16 of 30 non-survivors died, 2/3 of them were over 50 years of age at the time of death.

Figure 2  .

Figure 2  

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Kaplan-Meier cumulative survival plot. Skin involvement as a determinant of survival in systemic sclerosis. Improved survival for patients with limited systemic sclerosis (p=0.015).

Figure 3  .

Figure 3  

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Kaplan-Meier cumulative survival plot. Renal function measured by Cr-EDTA clearance as a determinant of survival in systemic sclerosis, grouping of patients according to severity score 0-1, 2, and 3-4. There is a significantly improved survival for those with severity score of 0-1 compared with severity score 2 (p<0.001).

Figure 4  .

Figure 4  

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Kaplan-Meier cumulative survival plot. Haemoglobin as a determinant of survival in systemic sclerosis. There is a significantly improved survival for patients with severity score of 0-1 compared with severity score 2 (p= 0.0003).

Figure 5  .

Figure 5  

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Kaplan-Meier cumulative survival plot. Lung function measured by vital capacity and static lung compliance as a determinant of survival in systemic sclerosis. Grouping of patients according to severity score 0-1, 2, and 3-4. Improved survival for those patients with severity score of 0-1 compared with severity scores 2 and 3-4 (p=0.0077).    

Figure 6  .

Figure 6  

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Kaplan-Meier cumulative survival plot. Gastrointestinal function measured by cinematography and triolein test as a determinant of survival in systemic sclerosis. Grouping of patients according to severity score 0-1, 2, and 3-4, showing improved survival for patients with severity score of 0-1 compared with severity scores 2 and 3-4 (p<0.0001).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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