Impact of gastrointestinal symptoms and psychological distress on quality of life in systemic sclerosis: a cross-sectional study

Abstract

Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease.

Objective: To evaluate the impact between gastrointestinal (GI) symptom burden and psychological well-being on HrQoL in patients with SSc.

Design: Nested cross-sectional study conducted between January and July 2022.

Participants: A single-centre cohort of 166 patients with SSc, including 103 (55%) with limited cutaneous SSc, 43 (24%) with diffuse SSc and 37 (21%) with sine-sclerosis SSc.

Main measures: GI symptom burden was assessed using the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0 (UCLA SCTC GIT 2.0) questionnaire, psychological well-being was measured with the Hospital Anxiety and Depression Scale (HADS), and HrQoL was evaluated using the Short Form 36 (SF-36) questionnaire. Demographic, clinical and immunological data were collected from a prospectively maintained database.

Key results: Patients with moderate to severe GI symptoms (UCLA SCTC GIT 2.0 score >0.5, n=95, 57%) reported decreased HrQoL in all subdomains except vitality by SF-36, and higher anxiety and depression scores by HADS (all p<0.05). The severity of GI symptom burden and depression were independently associated with a decline in the physical component of QoL (β=-0.273 and β=-0.411, respectively, p<0.01 for both). Only the severity of depression and anxiety (β=-0.482 and β=-0.213, respectively, p<0.05), but not GI symptom burden, were independently associated with a decline in the mental component of QoL.

Conclusions: Our data suggest that in patients with SSc, GI and psychological burden negatively influence quality of life independently, highlighting the need for a holistic approach to patient's care.

Keywords: Motility disorders; Psychological Stress; Quality of Life.

Figure 1. Comparison of QoL by SF-36 between patients without significant gastrointestinal (GI) symptom burden (UCLA GIT 2.0<0.5, n=71) and patients with moderate GI symptoms or more (UCLA GIT>0.5, n=95). Mean+SD SF-36 Scores for the eight domains and for the physical and mental component summaries are standardised. A score below 50 reflects worse HrQoL compared with the average of the general Spanish population *p<0.05: Significant differences by Mann Whitney U test. HrQoL, health-related quality of life; SF-36, Short Form 36; UCLA SCTC GIT 2.0, University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0.

Figure 2. Correlation matrix between the results of the SF-36 physical and mental component summaries scores, the UCLA SCTC GIT 2.0 subscales and total scores, and HADS depression and anxiety scores. Correlation was evaluated using Pearson’s R. HADS, Hospital Anxiety and Depression Scale; SF-36, Short Form 36; UCLA SCTC GIT 2.0, University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0.