Esclerose sistêmica em população de baixa renda: perfil clínico, epidemiológico e funcional em região de baixa latitude

Abstract

Systemic sclerosis (SSc) is a rare autoimmune disease characterized by vasculopathy, inflammation, and progressive fibrosis of the skin and internal organs, with heterogeneous clinical presentations and outcomes influenced by socioeconomic factors. This study aimed to describe the clinical, sociodemographic, and epidemiological profile of patients with SSc, as well as to analyze associations with clinical outcomes and functional capacity. This is an observational, descriptive, cross-sectional study with retrospective components, conducted at the Rheumatology Outpatient Clinic of the Walter Cantídio University Hospital in Fortaleza, Brazil. A total of 90 patients diagnosed with SSc were included after providing informed consent. Data were organized in electronic spreadsheets and analyzed using descriptive and inferential statistics according to variable distribution, with categorical variables expressed as absolute and relative frequencies. The study was approved by the Research Ethics Committee (CAAE: 77968023.7.0000.5054). The sample was predominantly female (92%) and self-reported as mixed-race (91.1%), with a mean age of 51.7±12.7 years. A higher frequency of the diffuse cutaneous subtype (55.5%) was observed, in contrast to the literature, which typically reports predominance of the limited form. Regarding social determinants, 30.1% had income below one minimum wage and 26.7% had low educational level. In terms of functional capacity, 60.7% of patients had mild impairment, approximately one-third had moderate impairment, and a small proportion had severe impairment, reflecting disease heterogeneity. Clinical manifestations included cutaneous involvement (skin thickening 90%), gastrointestinal involvement (gastroesophageal reflux 77.8%), and interstitial lung disease (65.4%). Raynaud’s phenomenon was observed in 75.6% of patients, a lower frequency than reported in other cohorts. Lower educational level was associated with higher inflammatory activity and higher modified Rodnan skin score, while lower income showed a tendency toward longer time to diagnosis.

Systemic sclerosis in this cohort presented a more severe profile, with predominance of the diffuse subtype and high frequency of pulmonary involvement. The lower prevalence of Raynaud’s phenomenon and the inversion in subtype distribution compared to the literature suggest possible regional clinical particularities. Socioeconomic factors showed a potential impact on disease progression, particularly regarding inflammatory profile and diagnostic delay, highlighting the need for a multidisciplinary approach and strategies that integrate clinical and social aspects to promote early diagnosis and greater equity in care.