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. 2023 Sep 1;62(9):3139-3145.
doi: 10.1093/rheumatology/kead093.

Rapid improvement of systemic sclerosis-associated intestinal pseudo-obstruction with intravenous immunoglobulin administration

Kazuki M Matsuda  1 , Ayumi Yoshizaki  1 , Ai Kuzumi  1 , Satoshi Toyama  1 , Kentaro Awaji  1 , Tomomi Miyake  1 , Shinichi Sato  1
Affiliations

Rapid improvement of systemic sclerosis-associated intestinal pseudo-obstruction with intravenous immunoglobulin administration

Kazuki M Matsuda et al. Rheumatology (Oxford). .

Abstract

Objectives: SSc is an autoimmune disease characterized by excessive fibrosis in multiple organs, including the gastrointestinal (GI) tract. GI symptoms of SSc such as intestinal pseudo-obstruction (IPO) are often refractory to conventional intervention and can result in longer in-hospital stay or even increased mortality. We aimed to summarize the insights to date regarding the efficacy of IVIG against GI symptoms of SSc to unveil what we should focus on in future studies.

Methods: Herein we report the response of GI symptoms in three cases with SSc-myositis overlap who received IVIG administration. We also conducted a systematic literature review to summarize previous reports regarding the efficacy of IVIG upon the GI manifestations of SSc, according to the PRISMA 2020 guideline.

Results: The case series demonstrated remarkable and rapid improvement of GI symptoms, including IPO, after IVIG administration. The literature review revealed that previous reports also support the efficacy and safety of IVIG against GI manifestations of SSc. However, they were all retrospective studies and lacking description of the short-term outcome after IVIG administration with objective and quantitative metrics.

Conclusion: IVIG seems to be a promising therapeutic option for the management of GI symptoms in SSc, including IPO. Investigators should focus more on short-term outcomes to properly assess the therapeutic benefit of IVIG, ideally using reliable quantitative measures in a multicentre randomized placebo-controlled setting.

Keywords: gastrointestinal; immunotherapy; scleroderma and related disorders; soft tissue rheumatism; systematic review.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Clinical course of the three presented cases. The longitudinal change of the patients’ body weight (BW), abdominal X-ray findings at each time point of BW measurement, and the therapeutic regimen is shown. IPO: intestinal pseudo-obstruction; IVCY: intravenous cyclophosphamide; PCI: pneumatosis cystoides intestinalis; PSL: prednisolone; TCR: tacrolimus; TPN: total parenteral nutrition
See this image and copyright information in PMC

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