Koletsos Nikolaos, Kaltsonoudis Evripidis, Trentzidis Konstantinos, Pelechas Elftherios, Gerolymatou Nafsika, Memi Tereza, Voulgari Paraskevi V
Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
Radiology Department, Theageneio Anticancer Hospital, Thessaloniki, Greece.
Rheumatology (Oxford). 2025 Jul 1;64(7):4320-4324. doi: 10.1093/rheumatology/keae639.
Systemic sclerosis (SSc) is a rare and complex autoimmune disease with significant complications. During the past few years, research interest has focused on the differences between female and male patients. However, there is a lack of data regarding the role of sex in the presence of small airway disease (SAD). Therefore, we aimed to investigate the impact of sex on pulmonary involvement in a cohort of SSc patients, focusing primarily on small airways.
For this retrospective study, consecutive patients with a diagnosis of SSc that visited our department up to January 2024 were recruited. Demographic data, disease manifestations, serological profile and internal organ involvement were compared between the two groups.
In total, 393 patients (female-to-male ratio 6:1) were included. Median time to diagnosis after the onset of Raynaud's was significantly longer for female patients. Electrocardiogram abnormalities were more common in male patients, while telangiectasias, calcinosis and arthralgias were more common in female individuals. Moreover, male SSc patients exhibited a higher prevalence of ILD and shorter time until the diagnosis of ILD. However, female individuals demonstrated a lower maximal-mid expiratory flow rate (MMEF) and higher ratio of residual volume to total lung capacity. Interestingly, sex remained an independent predictor of MMEF, in the multivariate analysis.
Our results showed that, although ILD is more common in male SSc patients, SAD was more prevalent among female individuals. Importantly, female sex remained an independent predictor of SAD. This study further supports the presence of sex-related differences in SSc, with important implications in disease course and management.
系统性硬化症（SSc）是一种罕见且复杂的自身免疫性疾病，伴有严重并发症。在过去几年中，研究兴趣集中在女性和男性患者之间的差异。然而，关于性别在小气道疾病（SAD）存在中的作用的数据却很缺乏。因此，我们旨在研究性别对一组SSc患者肺部受累的影响，主要关注小气道。
对于这项回顾性研究，招募了截至2024年1月到我们科室就诊的连续诊断为SSc的患者。比较了两组患者的人口统计学数据、疾病表现、血清学特征和内脏器官受累情况。
总共纳入了393例患者（女性与男性比例为6:1）。女性患者雷诺氏病发作后至诊断的中位时间明显更长。男性患者心电图异常更常见，而女性患者毛细血管扩张、钙质沉着和关节痛更常见。此外，男性SSc患者ILD的患病率更高，且至诊断ILD的时间更短。然而，女性患者的最大呼气中期流速（MMEF）较低，残气量与肺总量的比值较高。有趣的是，在多变量分析中，性别仍然是MMEF的独立预测因素。
我们的结果表明，虽然ILD在男性SSc患者中更常见，但SAD在女性患者中更普遍。重要的是，女性性别仍然是SAD的独立预测因素。这项研究进一步支持了SSc中存在性别相关差异，这对疾病进程和管理具有重要意义。
