Dr. Medsger has received speaking fees and/or honoraria (less than $10,000 each) from the American College of Rheumatology and the University of Michigan.
Significance of Palpable Tendon Friction Rubs in Early Diffuse Cutaneous Systemic Sclerosis
Article first published online: 26 JUL 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 8, pages 1385–1389, August 2013
How to Cite
Doré, A., Lucas, M., Ivanco, D., Medsger, T. A. and Domsic, R. T. (2013), Significance of Palpable Tendon Friction Rubs in Early Diffuse Cutaneous Systemic Sclerosis. Arthritis Care Res, 65: 1385–1389. doi: 10.1002/acr.21964
- Issue published online: 26 JUL 2013
- Article first published online: 26 JUL 2013
- Accepted manuscript online: 31 JAN 2013 11:22AM EST
- Manuscript Accepted: 15 JAN 2013
- Manuscript Received: 16 OCT 2012
- NIH Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: K23-AR057845-03
Palpable tendon friction rubs (TFRs) in systemic sclerosis (SSc; scleroderma) have been associated with diffuse skin thickening, increased disability, and poor survival. Our objective was to quantify the prognostic implications of palpable TFRs on the development of disease complications and longer-term mortality in an incident cohort of early diffuse cutaneous SSc (dcSSc) patients.
We identified early dcSSc patients (disease duration <2 years from the first SSc symptom) first evaluated at the University of Pittsburgh Scleroderma Center between 1980 and 2006 and found to have palpable TFRs. These patients were matched 1:1 with the next consecutive early dcSSc patient without TFRs as a control. All had ≥2 clinic visits and 5 years of followup from the first visit.
A total of 287 early dcSSc patients with TFR were identified and matched to 287 controls. The median disease duration was 0.83 years in TFR patients and 1.04 years in controls. The median followup was 10.1 years in TFR patients and 7.9 years in controls. Over the course of their illness, patients with TFRs had a >2-fold risk of developing renal crisis and cardiac and gastrointestinal disease complications, even after adjustment for other known risk factors. Patients with TFRs had poorer 5- and 10-year survival rates.
Patients with early dcSSc having ≥1 TFRs are at an increased risk of developing renal, cardiac, and gastrointestinal involvement before and after their first Scleroderma Center visit and have reduced survival. Patients presenting with TFRs should be carefully monitored for serious internal organ involvement.