Systemic sclerosis diagnostic criteria may be missing Black children

Skin changes and alopecia in a child with detectable SSc specific autoantibodies. Photo courtesy Elopy N Sibanda et al. (CC BY 4.0)

Systemic sclerosis (SSC) may be more common in Black children than previously thought, according to new findings. This discrepancy may be due to limitations in current diagnostic criteria, the authors of the study note in a press release on Dec. 9, 2021.

Researchers from The University of Edinburgh and Zimbabwe’s Asthma Allergy and Immunology Clinic, National University of Science and Technology, and the University of Zimbabwe analyzed records from more than 4,000 patients. Records included individuals aged between one and 94 years, who had presented at a specialist clinic between 2013 and 2018. Among those patients, 240 with symptoms of systemic sclerosis tested positive for SSC-specific autoantibodies. The findings were published in Frontiers in Immunology (Nov. 9, 2021; 12:679531).

One-fifth of those 240 were less than 16 years old, and 90% of the young patients were Black. The investigators found that the average age of the children with SSC autoantibodies was less than eight years.

Importantly, the research team also found that Black patients produce a different SSC-specific autoantibody to those seen in white patients. They write that this finding suggests that current diagnostic criteria, based on biomarkers identified in studies that primarily included white populations, underestimate the rate of the disease in Black people.

“Our study is the first to report high numbers of systemic sclerosis cases in Black children,” said the paper’s senior author Francisca Mutapi, DPhil, in the release. “This emphasizes the need to address racial biases in our diagnostic tools to ensure that people of all ethnicities receive effective diagnosis and treatment. These findings add to growing evidence that a lack of research involving women and people of colour is one of the key reasons why they often experience worse health outcomes.”

Dr. Mutapi is a Professor in Global Health Infection and Immunity at the University of Edinburgh and Deputy Co-Director of TIBA (Tackling Infections to Benefit Africa, a multi-national research group).

The investigators write that more research is needed to extend the diagnostic criteria for SSC to include symptoms seen in children and specific markers associated with Black people.