St. Vincent's Hospital Melbourne, Fitzroy, and The University of Melbourne, Melbourne, Victoria, Australia.
St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Arthritis Care Res (Hoboken). 2024 Dec;76(12):1686-1695. doi: 10.1002/acr.25426. Epub 2024 Oct 4.
The gastrointestinal tract (GIT) is the most commonly affected internal organ in systemic sclerosis (SSc). We sought to determine the prevalence and impact of GIT symptoms on survival and patient-reported outcomes.
A total of 907 consecutive patients from the Australian Scleroderma Cohort Study who had prospectively completed the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 Questionnaire (UCLA GIT) between 2015 and 2021 were included. The associations between UCLA GIT scores and physical function (Scleroderma Health Assessment Questionnaire), quality of life (QoL; Short Form 36), mood (Patient-Reported Outcomes Measurement Information System [PROMIS] anxiety and depression domains), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue score), and employment were investigated using multivariable population-averaged panel models using generalized estimating equations (GEEs). Kaplan-Meier curves and multivariable Cox proportional hazard regression models were used to evaluate survival according to total UCLA GIT scores.
GIT symptoms were reported in 87% of participants, with 46% to 52% reporting moderate to very severe symptoms of reflux, distension, diarrhea, and constipation. Higher total UCLA GIT scores were associated with worse QoL, physical function, fatigue, anxiety, and depression (P < 0.001). In the multivariable GEE analysis, moderate and severe to very severe total scores, reflux scores, and distension scores were associated with worse physical function, QoL, fatigue, anxiety, and depression compared to mild scores (P < 0.05). Patients with severe total scores and diarrhea scores were more likely to be unemployed compared to those with mild scores (P < 0.05). UCLA GIT total scores were not independently associated with death in our cohort.
GIT manifestations are common in SSc and negatively impact QoL, physical function, and employment but are not directly associated with increased death.
胃肠道（GIT）是系统性硬化症（SSc）最常受累的内部器官。我们旨在确定 GIT 症状对生存和患者报告结果的患病率和影响。
共纳入 907 例来自澳大利亚硬皮病队列研究的连续患者，这些患者于 2015 年至 2021 年期间前瞻性地完成了加利福尼亚大学洛杉矶分校硬皮病临床试验联盟胃肠道 2.0 问卷（UCLA GIT）。使用广义估计方程（GEE）的多变量总体平均面板模型研究了 UCLA GIT 评分与身体功能（硬皮病健康评估问卷）、生活质量（SF-36）、情绪（患者报告的结果测量信息系统[PROMIS]焦虑和抑郁领域）、疲劳（慢性疾病治疗疲劳功能评估量表）和就业之间的关系。Kaplan-Meier 曲线和多变量 Cox 比例风险回归模型用于根据总 UCLA GIT 评分评估生存情况。
87%的参与者报告有 GIT 症状，其中 46%至 52%报告有反流、腹胀、腹泻和便秘的中度至重度症状。较高的总 UCLA GIT 评分与较差的生活质量、身体功能、疲劳、焦虑和抑郁相关（P < 0.001）。在多变量 GEE 分析中，中度和重度至非常重度总分、反流评分和腹胀评分与轻度评分相比，与身体功能、生活质量、疲劳、焦虑和抑郁较差相关（P < 0.05）。与轻度评分相比，严重总分和腹泻评分的患者更有可能失业（P < 0.05）。在我们的队列中，UCLA GIT 总分与死亡无关。
GIT 表现在 SSc 中很常见，对生活质量、身体功能和就业产生负面影响，但与死亡率增加无直接关系。
