Gastrointestinal symptom severity and progression in systemic sclerosis

Abstract

Objectives: To evaluate the severity and evolution of patient-reported gastrointestinal tract (GIT) symptoms in systemic sclerosis (SSc) patients, assess predictive factors for progression and determine the impact of standard of care treatment.

Methods: SSc patients from the Leiden and Oslo cohorts were included. We assessed clinical data and patient-reported GIT symptoms measured by the validated University of California, Los-Angeles Gastrointestinal-tract (UCLA-GIT) score at baseline and annually. GIT severity and progression was determined. Logistic regression was applied to identify risk factors associated with baseline GIT symptom severity. Linear mixed-effect models were applied to assess progression in GIT symptom burden and to identify predictive factors. We repeated all analysis in patients with early disease (inception cohort) to exclude the effect of longstanding disease and increase insights in development of GIT symptom burden early in the disease course.

Results: We included 834 SSc patients with baseline UCLA GIT scores, 454 from Leiden and 380 from Oslo. In the total cohort, 28% reported moderate-severe GIT symptoms at baseline, with increased risk for severity conferred by ACA, smoking and corticosteroid use, while use of calcium channel blockers appeared protective. In the inception cohort, 23% reported moderate-severe GIT symptoms at baseline, with increased risk for females and with smoking. Over time, symptom burden increased mainly for reflux/bloating. Female sex and ACA predicted GIT symptom progression.

Conclusion: High GIT symptom burden is present early in SSc disease course. Both for prevalence and for progression of GIT symptom burden, female sex and smoking were identified as risk factors.

Keywords: SSc; gastrointestinal symptoms.

Fig. 1

Severity of gastrointestinal involvement at baseline in the total cohort and the inception cohort Disease severity at baseline according to the UCLA GIT 2.0 score on every subdomain in the total and the inception cohort. This figure shows the percentage of SSc patients with non-mild, moderate and severe gastro-intestinal involvement for each subdomain at baseline.

Fig. 2

Mean scores per GIT subdomain over the follow-up period in the inception cohort and the total cohort Mean scores per GIT subdomain over the follow-up period in the inception and the total cohort. Higher scores indicate worse GIT symptoms, lower scores indicate lesser GIT symptoms.

Fig. 3

Progressors (inception) for the total GIT score after 1 year stratified for immunomodulatory treatment Percentage of progressors in inception cohort. Inception patients with available UCLA GIT after one year (n = 118); n = 71 remained treatment-naïve, n = 47 started with immune-modulating therapy. No treatment are those patients who remained treatment-naïve.