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SSC and PAH


SSC and PAH


What is PAH?

A subtype of pulmonary hypertension (PH)

Pulmonary arterial hypertension (PAH) is a rare, progressive disease characterised by elevated pulmonary arterial pressure and vascular resistance that eventually leads to right ventricular failure and death[1]

Early identification and intervention are key to changing the course of the disease[2]

PAH is a severe and often fatal complication of CTD:[3]

  • It is most commonly seen in SSc, accounting for 75% of CTD-PAH cases[4]
  • Approximately 1 in 10 patients with SSc are estimated to have PAH[5]

PAH is a leading cause of death in patients with SSc, accounting for >50% of deaths in SSc-PAH patients[6]

What is PAH? - Different subcategories

Adapted from Badesch et al. 2010[7]

Early identification of PAH in patients with SSc is critical

Early recognition of PAH in SSc is difficult; symptoms at disease onset are mild and the complex nature of SSc makes interpretation of fatigue and breathlessness challenging[8]

However, early evaluation can lead to prompt referral and confirmation – and improved patient outcomes

When evaluating a patient with SSc, it is vital to look at the complete picture, including:

1. Patient history

  • Increasing breathlessness, reduced exercise tolerance, chest pain, ankle swelling and presyncopal symptoms could indicate the presence of PAH in your SSc patients[9]
  • These symptoms should prompt immediate consideration of PAH in your SSc patient[10]

2. Clinical examination

  • Look for features of right ventricular (RV) dysfunction[10]
  • Examine for an RV heave and raised jugular venous pressure (JVP)[10][11]

3. Non-invasive screening tests

  • Right heart echocardiography[12]
  • DLCO[12]
  • Circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP)[12]

Contact

Want to know more? Contact our medical team!

MATHIJS KRUK

Medical Scientific Liaison Pulmonary
Hypertension NL
+31 6 1238 17 11
mkruk1@its.jnj.com

ROB JANSSEN, PHD

Medical Advisor Pulmonary
Hypertension NL
+31 6 53 72 73 03
rjansse9@its.jnj.com

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Abbreviations

ALT, alanine aminotransferase; AST, aspartate aminotransferase;CHD, congenital heart disease; CI, confidence interval; CTD, connective tissue disease; ERA, endothelin receptor antagonist; ERS, European Respiratory Society; ESC, European Society of Cardiology; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, hazard ratio; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; PAH, pulmonary arterial hypertension; PH, pulmonary hypertension; PoPH, portopulmonary hypertension; RHC, right heart catheterisation; SSc, systemic sclerosis; TRV, tricuspid regurgitation velocity; ULN, upper limit of normal; 6MWD, six-minute walk distance

Referenties

Galiè N, et al. Eur Heart J 2010; 31(17):2080–2086
National Pulmonary Hypertension Centres of the UK and Ireland Heart 2008; 94:i1–i41
Rhee RL, et al. Am J Respir Crit Care 2015; 192(9):1111–1117
Zanatta E, et al. Exp Biol Med (Maywood) 2019; 244(2):120–131
Kiely DG, et al. Eur Heart J 2019; 21(Suppl K):K9–20
Kolstad KD, et al. Chest 2018; 154(4):862–871
Badesch DB, et al. Chest 2010; 137(2):376–387
Morrisroe K, et al. Arthritis Res Ther 2017; 19(1):42
McGoon M, et al. Chest 2004; 126(Suppl 1):14S–34S
Chaisson N, Hassoun P. Chest 2013; 144(4):1346–1356
Ryan J, et al. Can J Cardiol 2015; 31(4):391–406
Galiè N, et al. Eur Heart J 2016; 37(1):67–119
Coghlan JG, et al. Ann Rheum Dis 2014; 73(7):1340–1349
Galiè N, et al. Eur Heart J 2009; 30(20):2493-2537.)
Humbert M, et al. Arthritis Rheum 2011; 63(11):3522–353
Pulido T, et al. N Engl J Med 2013; 369(9):809–818
Sitbon O, et al. N Engl J Med 2015; 373(26):2522–2533
Gaine S, et al. Eur Respir J 2017; 50(2):1–9
OPSUMIT US Prescribing Information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/204410s017lbl.pdf (accessed February 2020)
CP-207909 - January 2021