Severe Gastrointestinal Disease in Early Systemic Sclerosis Linked to Increased Morbidity, Mortality

Digestive System
Digestive System
Severe gastrointestinal disease is common in early systemic sclerosis, and is linked to increased mortality.

The presence of severe gastrointestinal (GI) disease is associated with an increased risk for mortality and a significant impairment in health-related quality of life (HRQoL) among patients with early systemic sclerosis (SSc), according to results of a study published in Rheumatology.

The investigators sought to explore the incidence, predictors, and outcomes of severe GI disease in a large, multicenter cohort of patients with early SSc, hypothesizing that the onset of severe GI disease was related to enhanced morbidity and mortality. Participants in the study comprised individuals with SSc disease duration <2 years from 1 of 2 multicenter cohorts. Severe GI disease was defined as follows: malabsorption, hyperalimentation, pseudo-obstruction, or ≥10% weight loss in association with the use of antibiotics for either bacterial overgrowth or esophageal stricture.

Among patients in this inception SSc cohort, the likelihood of developing severe GI disease was estimated to be 9.1% at 2 years and 16.0% at 4 years. With the use of multivariate analysis, severe GI disease was associated with inflammatory myositis (odds ratio [OR], 4.68; 95% CI, 1.65-13.24), telangiectasias (OR, 2.45; 95% CI, 1.19-5.04), and modified Rodnan skin scores (OR, 1.03; 95% CI, 1.01-1.07).

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In addition, severe GI disease was linked to a >2-fold increased risk for mortality (hazard ratio, 2.27; 95% CI, 1.27-4.09) and significantly worse HRQoL (Short Form Health Survey physical [P =.02] and mental [P =.01] component summary scores).

The investigators concluded that additional research is warranted to comprehend, prevent, and alleviate severe GI disease in this patient population.

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Richard N, Hudson M, Wang M, et al; Canadian Scleroderma Research Group (CSRG); Australian Scleroderma Interest Group (ASIG). Severe gastrointestinal disease in very early systemic sclerosis is associated with early mortality [published online December 4, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key350