Scleroderma is a multisystem autoimmune disease with the highest case specific mortality rate of the rheumatic diseases. Literature on scleroderma mortality and its associated predictors has been disparate. The reasons for this variability include the rarity of the disease, small sample sizes and different methodologic approaches. As such, there is no validated method for predicting short or long term mortality in scleroderma. The objective of this proposal is to develop both a two- and five-year mortality risk prediction rule for patients with early diffuse scleroderma while using state of the art methodologic guidelines and a true inception cohort from a large, well- characterized, prospectively followed scleroderma population at the University of Pittsburgh.
Specific Aim la develops the prediction rules using regression analysis augmented by classification tree analysis.
Specific Aim lb internally validates the rules using the University of Pittsburgh Scleroderma cohort.
Specific Aim 2 a externally validates the two-year mortality prediction rule using cohorts from the Royal Free Hospital and the Scleroderma Clinical Trials Consortium.
Specific aim 2 b externally validates the five-year mortality prediction rule using the Royal Free Hospital scleroderma cohort. The development of prediction rules to calculate an individual patient's risk of two- and five-year mortality and ascertain factors associated with survival will have direct research and clinical applications. These prediction rules will be useful in clinical practice and to identify individuals at high risk of short and longer term mortality for inclusion in clinical trials of new therapies for scleroderma when mortality is an outcome measure. The ultimate goal of this line of research is to develop prediction rules that will fulfill the promise of personalized medicine for patients with scleroderma. The experience of developing and vaUdating prediction rules, combined with advanced methodologic training through didactic coursework and directed tutorials, will provide invaluable clinical research training, and help me attain my goal of becoming an independent physician scientist dedicated to improving the care and outcomes of scleroderma patients.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Witter, James
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Frech, Tracy M; Pauling, John D; Murtaugh, Maureen A et al. (2016) Sublingual Abnormalities in Systemic Sclerosis. J Clin Rheumatol 22:19-21
Domsic, Robyn T (2014) Scleroderma: the role of serum autoantibodies in defining specific clinical phenotypes and organ system involvement. Curr Opin Rheumatol 26:646-52
Domsic, Robyn T; Nihtyanova, Svetlana I; Wisniewski, Stephen R et al. (2014) Derivation and validation of a prediction rule for two-year mortality in early diffuse cutaneous systemic sclerosis. Arthritis Rheumatol 66:1616-24
Domsic, R T; Dezfulian, C; Shoushtari, Al et al. (2014) Endothelial dysfunction is present only in the microvasculature and microcirculation of early diffuse systemic sclerosis patients. Clin Exp Rheumatol 32:S-154-60
Chung, Lorinda; Domsic, Robyn T; Lingala, Bharathi et al. (2014) Survival and predictors of mortality in systemic sclerosis-associated pulmonary arterial hypertension: outcomes from the pulmonary hypertension assessment and recognition of outcomes in scleroderma registry. Arthritis Care Res (Hoboken) 66:489-95
Frech, Tracy M; Shanmugam, Victoria K; Shah, Ami A et al. (2013) Treatment of early diffuse systemic sclerosis skin disease. Clin Exp Rheumatol 31:166-71
Doré, Adam; Lucas, Mary; Ivanco, Dana et al. (2013) Significance of palpable tendon friction rubs in early diffuse cutaneous systemic sclerosis. Arthritis Care Res (Hoboken) 65:1385-9
Steen, Virginia; Domsic, Robyn T; Lucas, Mary et al. (2012) A clinical and serologic comparison of African American and Caucasian patients with systemic sclerosis. Arthritis Rheum 64:2986-94
Domsic, Robyn T; Medsger Jr, Thomas A (2011) Connective tissue diseases: Predicting death in SSc: planning and cooperation are needed. Nat Rev Rheumatol 7:628-30
Domsic, Robyn T; Rodriguez-Reyna, Tatiana; Lucas, Mary et al. (2011) Skin thickness progression rate: a predictor of mortality and early internal organ involvement in diffuse scleroderma. Ann Rheum Dis 70:104-9