Gastrointestinal symptom severity and progression in systemic sclerosis

Lara D. Veeken, vol. 61, pp. 4024–4034

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.

Authors 10

1. Nina Marijn van Leeuwen corresponding Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden, The Netherlands

2. Maaike Boonstra Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden, The Netherlands

3. Håvard Fretheim
   Affiliation as printed

   Department of Rheumatology

4. Cathrine Brunborg

   Oslo University Hospital

   Affiliation as printed

   Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital

5. Øyvind Midtvedt
   Affiliation as printed

   Department of Rheumatology

6. Torhild Garen
   Affiliation as printed

   Department of Rheumatology

7. Øyvind Molberg

   University of Oslo

   Affiliation as printed

   Department of Rheumatology

   Institute of Clinical Medicine, University of Oslo, Oslo, Norway

8. Tom W. J. Huizinga Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden, The Netherlands

9. Jeska Kirsten De Vries-Bouwstra Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden, The Netherlands

10. Anna‐Maria Hoffman‐Vold

    University of Oslo

    Affiliation as printed

    Department of Rheumatology

    Institute of Clinical Medicine, University of Oslo, Oslo, Norway