Gastrointestinal symptom severity and progression in systemic sclerosis

Area of Science:

• Rheumatology
• Gastroenterology
• Clinical Research

Background:

• Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis of the skin and internal organs.
• Gastrointestinal tract (GIT) dysfunction is a frequent and often severe complication in SSc patients, significantly impacting quality of life.

Purpose of the Study:

• To evaluate the severity and progression of patient-reported GIT symptoms in SSc.
• To identify predictive factors for GIT symptom severity and progression.
• To assess the impact of standard of care treatments on GIT symptoms in SSc.

Main Methods:

• Utilized data from the Leiden and Oslo cohorts, including 834 SSc patients with baseline University of California, Los-Angeles Gastrointestinal-tract (UCLA-GIT) scores.
• Assessed clinical data and patient-reported GIT symptoms annually using the validated UCLA-GIT score.
• Employed logistic regression and linear mixed-effect models to identify risk factors and predictive factors for GIT symptom burden and progression, including analysis of an early disease inception cohort.

Main Results:

• At baseline, 28% of the total cohort reported moderate-to-severe GIT symptoms. Increased risk was associated with anti-centromere antibody (ACA), smoking, and corticosteroid use, while calcium channel blockers showed a protective effect.
• In the inception cohort, 23% reported moderate-to-severe GIT symptoms at baseline, with higher risk in females and smokers.
• Over time, symptom burden increased, particularly for reflux and bloating. Female sex and ACA were identified as predictors of GIT symptom progression.

Conclusions:

• Significant GIT symptom burden is evident early in the course of SSc.
• Female sex and smoking are identified as significant risk factors for both the prevalence and progression of GIT symptoms in SSc patients.