Roth Eliane, Bruni Cosimo, Petelytska Liubov, Becker Mike Oliver, Dobrota Rucsandra, Jordan Suzana, Mihai Carina, Muraru Sinziana, Carreira Patricia E, De Vries-Bouwstra Jeska, Braun-Moscovici Yolanda, Liakouli Vasiliki, Moroncini Gianluca, Bergmann Christina, Mouthon Luc, Denton Christopher P, De Santis Maria, Cauli Alberto, Adler Sabine, Bernardino Vera, Truchetet Marie-Elise, Vonk Madelon, Del Galdo Francesco, Hoffmann-Vold Anna-Maria, Distler Oliver, Elhai Muriel
Department of Rheumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Rheumatology Department, Hospital Universitario 12 De Octubre, Madrid Spain.
Rheumatology (Oxford). 2025 Jan 8. doi: 10.1093/rheumatology/keaf016.
Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD.
SSc patients from the EUSTAR database with ILD were included. GERD was labeled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5-9% in association with relative DLCO decline of ≥ 15% over 12±3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression.
5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22-1.69], p < 0.001) and more severe lung involvement with lower FVC (85.8±22.1 vs 90.2±20.1, p < 0.001), lower DLCO (60.8±19.7 vs 65.3±20.6, p < 0.001) and worse performance at the 6-minute walking test. Female sex (HR: 1.39 [1.07-1.80], p = 0.012) and older age (HR: 1.02 [1.01-1.03], p < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD.
SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered as risk factor for ILD progression.
胃食管反流病（GERD）在系统性硬化症（SSc）中很常见，并且可能预测间质性肺病（ILD）的进展。我们旨在分析（1）SSc-ILD患者中GERD的患病率，（2）其与疾病特征的关联，以及（3）GERD的SSc-ILD患者中ILD进展的预测因素。
纳入来自EUSTAR数据库的患有ILD的SSc患者。如果在基线访视时或之前报告有反流/吞咽困难，则标记为存在GERD。在基线时比较有和没有GERD的患者的疾病特征。ILD进展定义为在12±3个月的随访期间，相对用力肺活量（FVC）下降≥10%或相对FVC下降5-9%且伴有相对一氧化碳弥散量（DLCO）下降≥15%。通过多变量Cox回归测试GERD的SSc-ILD患者中ILD进展、总生存期和无进展生存期的预后因素。
纳入了5462例SSc-ILD患者，4400例（80.6%）有GERD。有GERD的患者更常表现为弥漫性皮肤型SSc（比值比：1.44 [1.22-1.69]，p<0.001），且肺部受累更严重，FVC更低（85.8±22.1对90.2±20.1，p<0.001），DLCO更低（60.8±19.7对65.3±20.6，p<0.001），6分钟步行试验表现更差。女性（风险比：1.39 [1.07-1.80]，p=0.012）和年龄较大（风险比：1.02 [1.01-1.03]，p<0.001）独立预测GERD的SSc-ILD患者的ILD进展。
患有GERD的SSc-ILD患者似乎患有更严重的SSc疾病。在这一人群中，女性可能被视为ILD进展的危险因素。
