Spanish scleroderma risk score (RESCLESCORE) to predict 15-year all-cause mortality in scleroderma patients at the time of diagnosis based on the RESCLE cohort: Derivation and internal validation.

A few scores predicting the short-term risk of mortality in Systemic sclerosis (SSc) have been reported to date. Our study aimed to create a predictive 15-year all-cause mortality score at the time of the diagnosis of SSc. The study was based on the Spanish Scleroderma Registry (RESCLE). The cohort was split up in derivation (DC) and validation cohort (VC). A multivariate analysis to detect variables related to all-cause mortality within the first 15 years from SSc diagnosis was performed, assigning points to the rounded beta values to create the score (RESCLESCORE). 1935 SSc patients were included. The variables in the final model were as follows: age at diagnosis (+2 points > 65 years-old), male gender (+1 point), lcSSc subset (-1 point), mode of onset other than Raynaud's (+1 point), cancer (+1 point) and visceral involvement, such as ILD (+1 point), PAH (+1 point), heart (+1 point) and renal involvement (+2 points). Autoantibodies did not achieve statistical significance in the multivariate analysis. The 3 categories of risk to predict 15-year all-cause mortality at the time of diagnosis were as follows: low risk (5% vs. 7%, p = .189), intermediate risk (26.5% vs. 25.5%, p = .911) and high risk (47.8% vs. 59%, p = .316). The AUC was 0.799 (DC) vs. 0.778 (VC) (p = .530). In conclusion, the RESCLESCORE demonstrated an excellent ability to categorize SSc patients at the time of diagnosis in separate 15-year all-cause mortality risk strata at the time of diagnosis.

[Endothelial dysfunction is associated with insulin resistance in patients with rheumatoid arthritis]. / Relación entre disfunción endotelial y resistencia a la insulina en pacientes con artritis reumatoide.

BACKGROUND AND OBJECTIVES: There is an increased incidence of cardiovascular disease in rheumatoid arthritis (RA). Endothelial dysfunction is an early step in atherogenesis that is related to insulin resistance (IR). Our objective was to determine the relationship between endothelial dysfunction and IR in RA patients. The presence of other cardiovascular risk factors (CVRF) and their relationship with endothelial dysfunction and inflammatory markers was also evaluated. PATIENTS AND METHOD: Twenty RA patients without cardiovascular disease were studied. CVRF, treatments, body mass index, abdominal perimeter, clinical disease activity (DAS28), erythrocyte sedimentation rate, reactive C protein, lipid profile, homocysteine and insulin resistance (QUICKI) were determined. Endothelial function was measured by laser-doppler. RESULTS: We observed a positive correlation between the QUICKI index and microvascular endothelial function. We did not observe any relationship between endothelial function and inflammatory or clinical activity. CONCLUSIONS: In our population, the presence of IR in AR patients is associated with the development of endothelial dysfunction rather than with the degree of inflammatory response.