PAH markers identified among Chinese systemic sclerosis patients

By Afsaneh Gray, medwireNews Reporter

A study of Chinese patients with systemic sclerosis (SSc) has identified predictive markers for accompanying pulmonary arterial hypertension (PAH) similar to those that have been identified in other ethnic groups.

Five clinical and laboratory risk factors, including the presence of gastro-oesophageal reflux disease (GORD), telangiectasia and elevated immunoglobulin (Ig)A levels, were identified as being potentially predictive of PAH in SSc patients.

The study authors evaluated 236 patients with SSc prospectively enrolled at the Peking Union Medical College Hospital from 2009 to 2012. Thirty-three patients received right heart catheterisation for suspected PAH on the basis of electrocardiograph findings, of which 25 were determined to have PAH. This gave a prevalence of PAH in the study population of approximately 11%.

SSc patients with accompanying PAH were more likely than those without PAH to suffer from digital ulcers (52 vs 31%), GORD (60 vs 36%) and telangiectasia (64 vs 36%).

Lead author Xiaofeng Zeng (Peking Union Medical College Hospital) and colleagues also found that patients with PAH were more likely than those without to have elevated levels of serum immunoglobulin A (36 vs 16%). Tests for anti-nuclear antibodies showed that antibodies against U1 ribonucleoprotein (RNP, SSA and SSB) were also significantly more frequent in patients with PAH than controls, whereas anti-Scl-70 antibodies were more common in patients without PAH.

Logistic regression analysis showed that SSc patients with PAH were more likely than those without to have telangiectasia (odds ratio [OR]=2.9), GORD (OR=2.6), elevated IgA (OR=8.7) and to test positive for anti-RNP auto-antibodies (OR=24.4). An elevated forced vital capacity to total lung diffusion capacity for carbon monoxide ratio also increased the odds of having PAH (OR=97.0).

Writing in Clinical and Experimental Rheumatology, the researchers conclude that their results “may help predict which SSc patients require further invasive testing to rule out PAH, allowing for early diagnosis and management of this debilitating condition.”

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