Session Information
Date: Tuesday, November 7, 2017
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's – Clinical Aspects and Therapeutics Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Malnutrition is a major concern in systemic sclerosis (SSc) however literature is scarce on the subject, especially on micronutriment or vitamin deficiency and its relationship to disease outcomes. The aim of our study was to determine the prevalence and the risk factors associated with malnutrition, selenium (Se) and vitamine C (vitC) deficiency in SSc patients.
Methods: We included all unselected and consecutive adult SSc patient fulfilling the 2013 ACR/EULAR criteria the Toulouse University Hospital cohort between 2011 and 2016 who underwent a nutritional workup including (albumin, vitC and selenium plasma/serum levels). Patients were followed according to standard clinical guidelines with visits at least every 6 months. Data collected included clinical characteristics, organ involvement, pulmonary function tests, echocardiography parameters and drug exposure. Se deficiency was defined as serum Se < 70ng/mL. VitC deficiency was defined as serum vitC (determined by HPLC) < 0.4mg/dL. Comparisons were done using the Fisher’s exact test and the Wilcoxon signed-rank test and Association between malnutrition, Se or vitC deficiency was analyzed with logistic regression model.
Results: 82 consecutive SSc patients were included, mostly men (76%), mean aged was 59.7 ±13.5 years. SSc was limited, diffuse or sine scleroderma in 75%, 24% and 1% of cases respectively, with Scl-70 or centromere antibodies in 32% and 44% of cases. Mean disease duration was 9.4 ±9.9 years. 67.1% had a digital ulcer history. The mean modified rodnan skin score (mRSS) at baseline was 11 ±10. Cardiac, pulmonary or GI tract were involved in 19%, 63% and 39% of patients respectively; of whom 9% had pulmonary artery hypertension (PAH). Overt malnutrition was present in 13 (15.9%) patients. Micronutrient deficiencies included Se 19 (23.2%), vitC (26.8%), B6 37(45.1%), folate 11 (23%) and/or B1 4 (4.9%). Malnourished patients were significantly older (68.4 vs 58.1 y., p=0.01) and had more frequently PAH (27% vs 6%, p=0.05). Cardiac involvement was significantly associated with Se deficiency with an OR 6.2, IC95[1.48-32.7], p=0.02. Risk factors associated with vitC deficiency were BMI (OR 0.72 per point, IC95[0.54-0.89], p=0.01), Rodnan ≤ 14 (OR 0.16, IC95[0.03-0.68], p=0.02), interincisive distance (OR 0.91 per mm, IC95[0.81-0.99], p=0.04), esophagitis or Barrett’s mucosa (OR 4.85, IC95[1.48-17.0], p=0.01), pulmonary artery systolic pressure by echocardiography (OR 1.05 per mmHg, IC95[1.00-1.11], p=0.04), (OR 0.95 per %, IC95[0.90-0.99], p=0.04), DLCO (OR 0.95 per %, IC95[0.91-0.99], p=0.01), hemoglobin (OR 0.38 per g/dL, IC95[0.21-0.60], p=0.0002), albumin (OR 0.91 per g/L, IC95[0.82-0.99], p=0.05) and proton-pump inhibitor (OR 4.7, IC95[1.33-22.3], p = 0.03).
Conclusion: Se testing should be considered as soon as heart involvement is suspected. We believe that targeted Se supplementation could be beneficial to patients with heart involvement. VitC testing should be considered in SSc patients with extensive skin involvement and severe disease, and its supplementation should be a part of SSc close management.
To cite this abstract in AMA style:
Dupont R, Moulis G, Astudillo L, Arlet P, Sailler L, Pugnet G. Clinical Impact of Selenium and Vitamin C Deficiency in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/clinical-impact-of-selenium-and-vitamin-c-deficiency-in-systemic-sclerosis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-impact-of-selenium-and-vitamin-c-deficiency-in-systemic-sclerosis/