Session Information
Date: Monday, November 9, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Micronutrients are essential dietary factors involved in many metabolic processes, including oxidative stress, collagen synthesis and wound healing, which are key aspects of the pathogenesis of systemic sclerosis (SSc). Considering the frequent gastrointestinal involvement and impaired nutritional status (1,2), we hypothesized that the micronutrients could be profoundly affected in SSc patients.
Methods: Patients with SSc were prospectively included between 2009 and 2014. Clinical assessment, data recording and quality controls were done according to EUSTAR standards. In addition, the UCLA SCTC-GIT 2.0 questionnaire was applied. The following micronutrients were measured: zinc, selenium, prealbumin, holotranscobalamin, folic acid. Patients with a specific micronutrient deficiency or with deficiency in at least one micronutrient (“any deficiency”) were compared to patients with a normal micronutrient pattern. The two-sided Fisher’s exact test, the t-test and the Mann-Whitney were used, as appropriate. Multivariable logistic regression was applied to identify predictors of a deficiency in micronutrients in SSc patients.
Results: Nearly half (43.7%) of the 176 SSc patients included had a deficiency in at least one of the measured micronutrients. The most frequent deficit was in selenium (21.9%), followed by folic acid (16.6%) and prealbumin (15.0%). Even more, 19.3% of patients had multiple micronutrient deficiencies. There was a significant association between low levels of selenium and zinc, prealbumin and zinc and folic acid and zinc. Patients with a lower body mass index (BMI) had lower zinc levels, and those with low prealbumin had more stomach symptoms. The strongest (p<0.01) clinical parameters associated with any deficiency in micronutrients were lower hemoglobin (p<0.001), higher modified Rodnan skin score (p=0.007) and proximal skin thickening (p=0.009), as shown in Table 1. Proximal skin thickening, low hemoglobin and a low BMI were confirmed in the multivariable model as independent predictors of a deficit in micronutrients in patients with SSc.
Conclusion: Our study reveals that micronutrient deficiencies are a frequent burden in SSc patients and correlate with clinical aspects of the disease. Moreover, often more than one micronutrient is affected. In our cohort, patients with proximal skin fibrosis and lower BMI were more likely to show a deficiency in micronutrients, suggesting that screening for micronutrient status should be prioritized in these patients.
References:
- Cereda E, et al. Disease-related nutritional risk and mortality in systemic sclerosis. Clin Nutr. 2014 Jun;33(3):558-61.
- Krause L, et al. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis. 2010 Nov;69(11):1951-7.
Table 1. Correlations between disease characteristics and any micronutrient deficiency
|
Disease characteristics (frequencies) |
% of patients with disease characteristic present when there is any micronutrient deficiency |
% of patients with disease characteristic present when micronutrients are normal |
Fisher’s exact test, two-sided p value |
|
Skin thickening of the fingers of both hands extending proximal to the MCP joints |
61% (36/59) |
37.6% (29/77) |
p = 0.009 |
|
Pitting scars on fingertips |
47.4% (27/57) |
29.8% (23/77) |
p = 0.047 |
|
ACR-criteria for systemic sclerosis fulfilled |
78.2% (61/78) |
60% (57/95) |
p = 0.014 |
|
CK-elevation |
6.5% (5/77) |
19.8% (19/96) |
p = 0.014 |
|
Disease characteristics (mean +/- SD) |
Patients with any deficiency |
patients with no deficiencies |
Double t -test
|
|
BMI |
23.5 +/- 4.1 |
24.77 +/- 4 |
p = 0.048 |
|
Disease characteristics (median(quartile1,3)) |
Patients with any deficiency |
patients with no deficiencies |
Mann-Whitney U |
|
Modified Rodnan Skin Score |
6 (2, 11.25) |
3 (0, 8) |
p = 0.007 |
|
Erythrocyte sedimentation rate |
18 (8, 30) |
10 (6, 22.5) |
p = 0.027 |
|
HB (g/dl) |
12.4 (11.4, 13.5) |
13.6 (12.7, 14.325) |
p<0.001 |
|
ACR, American College of Rheumatology; BMI, Body-Mass-Index; CK, creatine kinase; HB, Hemoglobin; MCP, metacarpophalangeal joint. Normal serum levels of the micronutrients: zinc: 9 – 21µmol/l, selenium: 0.8 – 1.1µmol/l, prealbumin: 200 – 400mg/l, folic acid: > 4 µg/l, holotranscobalamin: > 35pmol/l. Measurement techniques: zinc – flame atomic absorption spectrometry (F-AAS); selenium – graphite furnace atomic absorption spectrometry (GF-AAS); prealbumin – immunonephelometry; holotranscobalamin – chemiluminescence microparticle immunoassay (CMIA); folic acid – chemiluminescence immunoassay. |
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To cite this abstract in AMA style:
Laeubli J, Dobrota R, Maurer B, Jordan S, Misselwitz B, Fox M, Distler O. Deficiency in Micronutrients Is a Frequent Burden in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/deficiency-in-micronutrients-is-a-frequent-burden-in-patients-with-systemic-sclerosis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/deficiency-in-micronutrients-is-a-frequent-burden-in-patients-with-systemic-sclerosis/