The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis
Objective Our objective was to define the frequency and impact of multimorbidity in systemic sclerosis (SSc). Method Australian Scleroderma Cohort Study participants meeting American College of Rheumatology/EULAR criteria were included. Charlson Comorbidity Index scores were calculated at each visit...
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| Format: | Article |
| Language: | English |
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Wiley
2025-04-01
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| Series: | ACR Open Rheumatology |
| Online Access: | https://doi.org/10.1002/acr2.70034 |
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| author | Jessica L. Fairley Dylan Hansen Susanna Proudman Joanne Sahhar Gene‐Siew Ngian Diane Apostolopoulos Jennifer Walker Lauren V. Host Wendy Stevens Mandana Nikpour Laura Ross |
| author_facet | Jessica L. Fairley Dylan Hansen Susanna Proudman Joanne Sahhar Gene‐Siew Ngian Diane Apostolopoulos Jennifer Walker Lauren V. Host Wendy Stevens Mandana Nikpour Laura Ross |
| author_sort | Jessica L. Fairley |
| collection | DOAJ |
| description | Objective Our objective was to define the frequency and impact of multimorbidity in systemic sclerosis (SSc). Method Australian Scleroderma Cohort Study participants meeting American College of Rheumatology/EULAR criteria were included. Charlson Comorbidity Index scores were calculated at each visit, with multimorbidity defined as scores ≥4. Generalized estimating equations were used to model longitudinal data in multivariable models including age, sex, subclass, interstitial lung disease, and pulmonary arterial hypertension status. Survival was analyzed using Cox hazard modeling. Results Of 2,000 participants, 85% were female, 27% had diffuse SSc, and 20% had multimorbidity. Among those with multimorbidity, key comorbidities were hypertension (81%), dyslipidemia (67%), obstructive lung disease (50%), malignancy (49%), and ischemic heart disease (IHD) (40%). Multimorbidity was associated with worse survival (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.30–1.91, P < 0.01). Renal disease had the largest impact (HR 2.41, 95% CI 1.46–3.98, P < 0.01), followed by left ventricular dysfunction (HR 1.76, 95% CI 1.21–2.57, P < 0.01), anticoagulation (HR 1.64, 95% CI 1.28–2.08, P < 0.01), and IHD (HR 1.45, 95% CI 1.16–1.80, P < 0.01). In multivariable modeling, multimorbidity was associated with poorer physical function (regression coefficient [RC] +0.17 units, 95% CI 0.13–0.21, P < 0.01). Peripheral vascular disease had the largest impact on physical function (RC +0.26 units, 95% CI 0.18–0.34, P < 0.01), followed by left ventricular dysfunction (RC +0.23 units, 95% CI 0.14–0.33, P = 0.01), IHD (RC +0.22 units, 95% CI 0.17–0.28, P < 0.01), and obstructive lung disease (RC +0.19 units, 95% CI 0.14–0.24, P < 0.01). Conclusion Multimorbidity occurred in 20% of patients in a large SSc cohort and was an important determinant of both prognosis and physical function. Effective treatment of non‐SSc morbidity may improve outcomes for patients with SSc. |
| format | Article |
| id | doaj-art-9d23ca87444e4153b04e7ca9cf9dc308 |
| institution | OA Journals |
| issn | 2578-5745 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| series | ACR Open Rheumatology |
| spelling | doaj-art-9d23ca87444e4153b04e7ca9cf9dc3082025-08-20T02:32:15ZengWileyACR Open Rheumatology2578-57452025-04-0174n/an/a10.1002/acr2.70034The Prognostic and Functional Impact of Multimorbidity in Systemic SclerosisJessica L. Fairley0Dylan Hansen1Susanna Proudman2Joanne Sahhar3Gene‐Siew Ngian4Diane Apostolopoulos5Jennifer Walker6Lauren V. Host7Wendy Stevens8Mandana Nikpour9Laura Ross10The University of Melbourne and St. Vincent's Hospital Melbourne Melbourne AustraliaSt. Vincent's Hospital Melbourne Melbourne AustraliaUniversity of Adelaide and Royal Adelaide Hospital Adelaide AustraliaMonash Health and Monash University Melbourne AustraliaMonash Health and Monash University Melbourne AustraliaMonash Health and Monash University Melbourne AustraliaRoyal Adelaide Hospital and Flinders University of South Australia Adelaide AustraliaFiona Stanley Hospital Murdoch AustraliaThe University of Melbourne and St. Vincent's Hospital Melbourne Melbourne AustraliaUniversity of Sydney School of Public Health, Royal Prince Alfred Hospital Sydney and University of Sydney Sydney AustraliaThe University of Melbourne and St. Vincent's Hospital Melbourne Melbourne AustraliaObjective Our objective was to define the frequency and impact of multimorbidity in systemic sclerosis (SSc). Method Australian Scleroderma Cohort Study participants meeting American College of Rheumatology/EULAR criteria were included. Charlson Comorbidity Index scores were calculated at each visit, with multimorbidity defined as scores ≥4. Generalized estimating equations were used to model longitudinal data in multivariable models including age, sex, subclass, interstitial lung disease, and pulmonary arterial hypertension status. Survival was analyzed using Cox hazard modeling. Results Of 2,000 participants, 85% were female, 27% had diffuse SSc, and 20% had multimorbidity. Among those with multimorbidity, key comorbidities were hypertension (81%), dyslipidemia (67%), obstructive lung disease (50%), malignancy (49%), and ischemic heart disease (IHD) (40%). Multimorbidity was associated with worse survival (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.30–1.91, P < 0.01). Renal disease had the largest impact (HR 2.41, 95% CI 1.46–3.98, P < 0.01), followed by left ventricular dysfunction (HR 1.76, 95% CI 1.21–2.57, P < 0.01), anticoagulation (HR 1.64, 95% CI 1.28–2.08, P < 0.01), and IHD (HR 1.45, 95% CI 1.16–1.80, P < 0.01). In multivariable modeling, multimorbidity was associated with poorer physical function (regression coefficient [RC] +0.17 units, 95% CI 0.13–0.21, P < 0.01). Peripheral vascular disease had the largest impact on physical function (RC +0.26 units, 95% CI 0.18–0.34, P < 0.01), followed by left ventricular dysfunction (RC +0.23 units, 95% CI 0.14–0.33, P = 0.01), IHD (RC +0.22 units, 95% CI 0.17–0.28, P < 0.01), and obstructive lung disease (RC +0.19 units, 95% CI 0.14–0.24, P < 0.01). Conclusion Multimorbidity occurred in 20% of patients in a large SSc cohort and was an important determinant of both prognosis and physical function. Effective treatment of non‐SSc morbidity may improve outcomes for patients with SSc.https://doi.org/10.1002/acr2.70034 |
| spellingShingle | Jessica L. Fairley Dylan Hansen Susanna Proudman Joanne Sahhar Gene‐Siew Ngian Diane Apostolopoulos Jennifer Walker Lauren V. Host Wendy Stevens Mandana Nikpour Laura Ross The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis ACR Open Rheumatology |
| title | The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis |
| title_full | The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis |
| title_fullStr | The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis |
| title_full_unstemmed | The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis |
| title_short | The Prognostic and Functional Impact of Multimorbidity in Systemic Sclerosis |
| title_sort | prognostic and functional impact of multimorbidity in systemic sclerosis |
| url | https://doi.org/10.1002/acr2.70034 |
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