Alcala-Gonzalez Luis G, Burton-Murray Helen, Atkins Micaela, Guillen-Del-Castillo Alfredo, Malagelada Carolina, Hughes Michael, McMahan Zsuzsanna H, Simeón-Aznar Carmen P
Digestive System Research Unit, Digestive Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Massachusetts General Hospital and Harvard Medical School, Boston.
Arthritis Care Res (Hoboken). 2025 May 12. doi: 10.1002/acr.25569.
Patients with systemic sclerosis (SSc) may restrict food intake to manage their symptoms (particularly gastrointestinal [GI]). Whether some patients may develop nutritional and/or quality-of-life impairments indicative of an eating disorder, avoidant or restrictive food intake disorder (ARFID), is unknown. We aimed to (1) identify the prevalence and characteristics of ARFID symptoms in patients with SSc and (2) explore the relationship among ARFID symptoms, GI symptom burden, and health-related quality of life.
In a cross-sectional internet survey nationwide in Spain, patients with SSc completed the Spanish Nine-Item ARFID Screen and assessments of gastrointestinal symptom burden (University of California Los Angeles Scleroderma Clinical Trial Consortium GI tract 2.0 [UCLA SCTC GIT 2.0]) and health-related quality of life (12-item Short Form Survey [SF-12]).
Of 200 patients with SSc, 99 patients (49.5%) screened positive for ARFID. Just over half of those who screened positive for ARFID (n = 53) screened positive based on having a fear of aversive consequences around eating (eg, GI discomfort). A positive ARFID screen was associated with a greater frequency of self-reported enteral nutrition, weight loss, and self-initiated (vs provider-monitored) diet restrictions. ARFID symptoms were moderately associated with worse GI symptom severity by UCLA GIT 2.0 total score (r = 0.408, P < 0.001) but not for the reflux subscale (r = 0.058, P = 0.420) and constipation subscale (r = 0.090, P = 0.209) and with worse health-related quality of life in all domains and both the physical and mental components of the SF-12 (all P < 0.05).
ARFID symptoms were relatively common in patients with SSc. Future research is needed to identify when a positive screen for ARFID reflects an adaptive response to disease or pathologic restriction indicative of ARFID warranting behavioral treatment.
系统性硬化症（SSc）患者可能会限制食物摄入量以控制症状（尤其是胃肠道[GI]症状）。目前尚不清楚部分患者是否会出现提示饮食失调、回避或限制食物摄入障碍（ARFID）的营养和/或生活质量损害。我们旨在（1）确定SSc患者中ARFID症状的患病率及特征，以及（2）探讨ARFID症状、胃肠道症状负担和健康相关生活质量之间的关系。
在西班牙全国范围内开展的一项横断面网络调查中，SSc患者完成了西班牙文版的九项ARFID筛查问卷，并接受了胃肠道症状负担评估（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版[UCLA SCTC GIT 2.0]）和健康相关生活质量评估（12项简明健康调查问卷[SF - 12]）。
在200例SSc患者中，99例（49.5%）ARFID筛查呈阳性。ARFID筛查呈阳性的患者中，略超过一半（n = 53）是因为害怕进食带来不良后果（如胃肠道不适）而筛查呈阳性。ARFID筛查呈阳性与自我报告的肠内营养、体重减轻以及自行（而非由医护人员监测）进行饮食限制的频率更高相关。ARFID症状与UCLA GIT 2.0总分所反映的更严重的胃肠道症状严重程度中度相关（r = 0.408，P < 0.001），但与反流子量表（r = 0.058，P = 0.420）和便秘子量表（r = 0.090，P = 0.209）无关，并且与SF - 12所有领域以及身体和心理成分中更差的健康相关生活质量相关（所有P < 0.05）。
ARFID症状在SSc患者中相对常见。未来需要开展研究，以确定ARFID筛查呈阳性何时反映出对疾病的适应性反应，何时反映出需要行为治疗的ARFID病理性限制。
