A comparison between general rheumatologists and scleroderma experts with respect to following systemic sclerosis guidelines

Objective. To determine if there are differences between expert and non-expert rheumatologists in systemic sclerosis (SSc) management. Methods. Information relating to demographics, complications, investigations, and treatment of SSc patients was obtained from an online survey to members of the Canadian Rheumatology Association (CRA), and selected chart audits. Results were compared to data from a SSc database ('experts', Canadian Scleroderma Research Group - CSRG). Results. The online survey (611300 respondents; 20% response rate) found that most agreed with the EULAR SSc guidelines. Some exceptions were only 47% said they ordered annual echocardiograms and 45% pulmonary function tests. Chart audits of 70 SSc patients from 7 community rheumatology practices revealed no significant differences in their treatment from SSc guidelines, but some investigations differed compared to the CSRG. There was site variability among community practices relating to investigations, and treatment. Patients receiving an echocardiogram within the previous year varied from 10-90%, and PA pressure was reported in 30-100% of SSc patients among sites. Overall, 91% of SSc patients on chart audit had ever received an echocardiogram, but in 30% of cases there was no PA pressure recorded versus only 19% in CSRG (p=0.001). Conclusion. Compared to SSc experts, general rheumatologists did not differ in their practices for many SSc guidelines despite the fact that they do not see many SSc patients when compared to SSc experts, but there was site variability. An apparent difference is that although echocardiograms are being ordered, PA pressures are missing which could lead to late detection of PAH.