Material and Method: An historical cohort study was performed among referred-SSc patients at Srinagarind Hospital between January 2006 and December 2010. ‘Early referrals’ occurred during the edematous phase while ‘late referrals’ occurred after that.

Results: Forty two percent of the SSc cases (229 of 543) were referred; 108 (47.2%) were early-referrals. Early referrals were for proper management (49.1%) and diagnosis (41.7%), whereas the majority of late referrals (79.3%) were for proper management, followed by additional investigations (10.7%). The respective median duration of disease at referral between early and late was 3.7 (IQR 2.6-5.6) and 20.7 months (IQR 12.2-37.4). Joint contracture, cardiac involvement and pulmonary fibrosis presented more frequently among late-referrals (p<0.001, p = 0.03 and p = 0.04, respectively). The respective mortality rate among early- vs. late-referrals was 15.1 (95% CI 10.0-21.8) vs. 23.0 (95% CI 15.8-32.3) per 100 person-year. Two-thirds of deaths were associated with the disease, pulmonary fibrosis being most common among both early- and latereferrals (50 and 42.7%, respectively).

Conclusion: The number of early vs. late referrals was comparable and cardiopulmonary involvement and joint contracture were common presentations in late-referrals. Late-referral was associated with high mortality commonly from pulmonary fibrosis.

Keywords: Systemic sclerosis (SSc), Scleroderma, Refer, Mortality, Autoimmune disease