{
  "abstract": "Introduction Systemic sclerosis (SSc), is an uncommon autoimmune disease mainly characterized by fibrosis, inflammation and vasculopathy of the skin and internal organs. Although classification criteria (2013 ACR/EULAR) facilitate diagnosis at the time of established disease, mounting evidence suggests that a prolonged preclinical, often spanning several years before formal diagnosis, during which subtle clinical and serologic abnormalities may emerge.Material and Methods In this population-based case control study using the Leumit Healthcare Services (LHS) database, we aimed to describe the medical history within 5 years prior to diagnosis of SSc compared to age and gender matched controls. The medical history of interest included medical diagnoses, comorbidities, expert consultations, diagnostic procedures, medications and vaccinationsResults Our study included 553 SSc patients and 2765 matched controls. Table 1 summarized the baseline characteristics and the relevant more prevalent comorbidities. SSc patients have significantly more certain cardiac, pulmonary, neurologic, dermatologic, ophthalmic and rheumatologic comorbidities. Table 2 presents the most common diagnoses given to SSc patients prior to diagnosis and include musculoskeletal, gastrointestinal, dermatologic and neurologic. Raynaud’s phenomenon, morphea, polyarthropathy, dysphagia, edema and candidiasis of the mouth were the most significant diagnoses differentiating between SSc patients and controls. In general, SSc patients consume more expert consultations, especially orthopedists, dermatologists and ophthalmologists, table 3. Regarding medications, SSc patients use more commonly specific drugs classes compared to controls, including systemic and topical glucocorticoids, anti-histamines, anti-acids (proton pump inhibitors, H2 blockers), antibiotics, calcium channel blockers, NSAIDs and pain killers. No significant differences between SSc patients and controls were identified in the case of vaccinations.Conclusions Prior to diagnosis, SSc patients consume more medical services as exemplified by more frequent experts’ consultations, the use of specific classes of medication and diagnostic procedures. Moreover, they present with typical manifestations of the disease months to years before diagnosis. Therefore, high index of suspicion and early referral to rheumatologists should are mandatory to avoid delays in diagnosis and the occurrence of irreversible damage.Abstract P.308 Table 1Abstract P.308 Table 2Abstract P.308 Table 3",
  "authors": [
    {
      "affiliations": [
        "Galilee Medical Center, Nahariyya, Israel"
      ],
      "name": "Helana Jeries"
    },
    {
      "affiliations": [
        "Faculty of Medical & Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Leumit Research Institute, Leumit Health Services, Tel-Aviv, Israel"
      ],
      "name": "Ariel Israel"
    },
    {
      "affiliations": [
        "Faculty of Medical & Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Leumit Research Institute, Leumit Health Services, Tel-Aviv, Israel"
      ],
      "name": "Eugene Marzon"
    },
    {
      "affiliations": [
        "Galilee Medical Center, Nahariyya, Israel",
        "Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel"
      ],
      "name": "Mohammad E Naffaa"
    }
  ],
  "title": "P.308 The consumption of medical health services by systemic sclerosis patients up to five years prior to diagnosis: a population -based case control study",
  "uid": "63d99865-85cb-5816-895f-0d8d9cea069e"
}