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In patients with systemic sclerosis, gastrointestinal manifestations are common and negatively affect quality of life, employment, and physical function, but are not directly linked with increased death.
A large-scale study from the Australian Scleroderma Cohort Study highlighted the widespread burden of gastrointestinal (GIT) disturbances in systemic sclerosis (multiorgan autoimmune disorder of the connective tissues), revealing their substantial impact on daily functioning, mental health, and employment, but not on survival. The findings, based on data from 907 patients who finished the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 Questionnaire (UCLA GIT 2.0) between 2015 and 2021, shed light on the crucial yet often overlooked effects of GIT involvement in systemic sclerosis (also known as scleroderma).
In this study, researchers explored the link between GIT symptom severity and patient-reported outcomes, including employment, fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue score), mood (Patient-Reported Outcomes Measurement Information System [PROMIS] anxiety and depression), physical function (Scleroderma Health Assessment Questionnaire), and quality of life (Short Form 36). Multivariable population-averaged panel models via generalized estimating equations were utilized for analysis.
Additionally, survival was examined based on total UCLA GIT scores utilizing Kaplan-Meier curves and multivariable Cox proportional hazard regression models. GIT symptoms were highly prevalent, affecting 87% of patients, with nearly half (46% to 52%) reporting moderate-to-very severe reflux, bloating, constipation, and diarrhea. Higher UCLA GIT scores were strongly linked to poorer quality of life, reduced physical function, increased fatigue, and heightened levels of anxiety and depression.
Multivariable analysis further revealed that those with moderate-to-severe reflux and bloating experienced substantially worse overall well-being. Severe GIT symptoms, particularly diarrhea, were related to a greater risk of unemployment. Despite these challenges, the study did not find an independent association between severe GIT symptoms and increased mortality. While systemic sclerosis is known to carry a high risk of complications and death, GIT involvement alone did not appear to directly contribute to this risk in the cohort studied.
Arthritis Care & Research
Prevalence and Outcomes of Gastrointestinal Manifestations in an Australian Scleroderma Cohort
Alannah Quinlivan et al.
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