Session Information
Date: Tuesday, November 7, 2017
Session 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: Gastrointestinal (GI) system involvement is commonly seen in sytemic sclerosis (SSc) up to 90% of the patients during disease duration and one of the substantial causes of morbidity and mortality in SSc. We aimed to investigate self-reported questionnaires and capillaroscopy in terms of severity of GI involvement and malnutrition in SSc patients.
Methods: GI involvement and nutrition status were evaluated by UCLA SCTC GIT 2.0 questionnaire and ‘malnutrition universal screening tool (MUST) in SSc patients fulfilling ACR/EULAR classification criteria (2013). Simultaneously; ealy, active and late scleroderma patterns (Cutolo et al.) were determined qualitatively and capillary number (CN) was calculated per linear mm at distal row quantitatively by using nail fold video-capillaroscopy (NVC) in all patients.
Results:
In 126 SSc patients (115 female) with the mean age of 50±12, duration of non-Raynaud symptom of 10±9 years and follow-up of 53±58 months; diffuse cutaneous form was found to be 25% (n=32), anti-Scl70 positivity 32% (n=37), telangiectases 81%(n=102), digital ulcers 44% (n=55), lung disease 40% (n=49) and flexion contractures 15% (n=18). Of the NVC patterns, early was found in 31 (25%), active was in 18 (14%), late was in 68 (54%) and normal in 9 (7%). The scores of skin, telangiectasia, disease activity and UCLA SCTC GIT 2.0 total, reflux and distension items were shown to be higher in patients with late NVC pattern (table-1). The patients with CN≤5 were found to be have higher scores of UCLA SCTC GIT 2.0 total, reflux, distension, soilage, social items and MUST (p<0,001, p<0,001, p=0,001, p=0,002 and p=0,002) and scores of skin, telangiectasia, disease activity and severity (p<0,001, p<0,001, p=0,001 and p=0,003). Of the patients with MUST score of ≥1 (n=18), 16 had late, 1 early NVC pattern and 1 normal pattern.
Conclusion: This SSc cohort predominantly had vascular manifestations. Late scleroderma pattern and decreased capillary dansity was found to be related to severe GI complaints, disease activity, skin severity and telangiectases. Undernutrition was also frequently seen in patients with late pattern. NVC might be useful to predict the severity of GI and malnutrition.
Table-1: The scores of disease activity and severity and UCLA SCTC GIT 2.0 in SSc patients
|
|
NVC (normal) |
NVC (early) |
NVC (active) |
NVC (late) |
p |
|
Modified Rodnan skin score |
2,2±2,5 |
3,9±4,6 |
7,3±5,9 |
9,63±6,9 |
P<0,001 |
|
Telangiectasia score |
1,1±1,6 |
2,4±2,6 |
4,9±2,5 |
5,6±3,4 |
P<0,001 |
|
Disease activity score |
1,1±0,7 |
0,7±0,9 |
1,2±1,0 |
1,6±1,4 |
P=0,010 |
|
Disease severity score |
3,3±1,2 |
4,5±5,9 |
4,7±2,2 |
5,9±2,7 |
NS |
|
UCLA SCTC GIT 2.0-total |
0,08±0,11 |
0,09±0,12 |
0,21±0,24 |
0,33±0,31 |
P<0,001 |
|
reflux |
0,26±0,36 |
0,35±0,39 |
0,57±0,50 |
0,85±0,65 |
P<0,001 |
|
Distension |
0,17±0,42 |
0,06±0,20 |
0,20±0,41 |
0,50±0,84 |
P=0,015 |
|
soilage |
0±0 |
0±0 |
0±0 |
0,18±0,49 |
NS |
|
Diarrhea |
0±0 |
0,10±0,40 |
0,31±0,62 |
0,23±0,52 |
NS |
|
social functioning |
0,04±0,11 |
0±0 |
0,06±0,19 |
0,14±0,31 |
NS |
|
emotional wellbeing |
0,02±0,07 |
0±0 |
0,13±0,30 |
0,10±0,28 |
NS |
|
constipation |
0,22±0,46 |
0,15±0,42 |
0,18±0,34 |
0,15±0,36 |
NS |
NS=not significant
To cite this abstract in AMA style:
Yalçınkaya Y, Erturk Z, Pehlivan O, Unal AU, Atagunduz P, Direskeneli H, Inanc N. The Association between Two Non-Invasive Methods for the Assessment of Severity of Gastrointestinal Involvement and Malnutrition in Systemic Sclerosis: Self-Reported Questionnaires and Nail Fold Video-Capillaroscopy [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-association-between-two-non-invasive-methods-for-the-assessment-of-severity-of-gastrointestinal-involvement-and-malnutrition-in-systemic-sclerosis-self-reported-questionnaires-and-nail-fold-video/. Accessed December 9, 2018.« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-two-non-invasive-methods-for-the-assessment-of-severity-of-gastrointestinal-involvement-and-malnutrition-in-systemic-sclerosis-self-reported-questionnaires-and-nail-fold-video/