P156 Understanding the associations and impact of severe gastrointestinal involvement in systemic sclerosis: a structured approach

Abstract

Abstract Background Gastrointestinal (GI) involvement in systemic sclerosis (SSc) has a profound negative impact on patients’ quality of life. However, due to the diversity in manifestations of SSc-associated GI disease, this impact has proven difficult to quantify and to associate with other clinical and demographic features, to identify those most at risk of severe disease. Methods Between September and December 2018, consecutive SSc patients attending a specialist scleroderma clinic completed the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) questionnaire. Total score and separate domain scores (reflux, distention/bloating, diarrhoea, soilage, constipation, social functioning and emotional wellbeing) were calculated. Domain scores range between 0 and 3, with higher scores indicating greater severity. Associations between mean scores and demographic or clinical characteristics were analysed using Wilcoxon rank-sum test. Results In total, 224 SSc patients fully completed the UCLA SCTC GIT 2.0. Eighty-three percent were female, mean age was 58.2 years and mean disease duration was 14.3 years. Diffuse cutaneous systemic sclerosis (dcSSc) was present in 37.1%, and 22.3% had an overlap syndrome. The most common autoantibodies were anti-centromere (ACA) in 38.0%, anti-topoisomerase I (ATA) in 20.1%, anti-RNA polymerase in 11.2% and anti-U3RNP in 4.5% of patients. For the cohort, the total GIT score was 0.62±0.57 (mean±SD), correlating strongly with visual analogue scale self-reported impact of GI disease (Pearson’s r = 0.72, p < 0.001). Distribution of total and domain scores is summarised in Table 1. We found no association between demographic or clinical characteristics and total GIT score, reflux, distention/bloating, diarrhoea and social functioning. Constipation was most common among ATA + (score 0.69, p = 0.080 v ATA-) and least common among ARA+ subjects (score 0.25, p = 0.014 v ARA-). Soilage was more common in limited cutaneous SSc (score 0.56 v 0.29 in dcSSc, p = 0.048) and ACA+ subjects (score 0.67 v 0.33 in ACA-, p = 0.008). ACA+ patients also had worse emotional wellbeing (score 0.70 v 0.52 in ACA-, p = 0.014). Emotional wellbeing was more severely affected in females (score 0.62 v 0.43 in males, p = 0.078). Conclusion We found that moderate to severe GI disease affects nearly half of all subjects with SSc, which significantly contributes to disease-related morbidity. Disclosures F. Ahmed None. S.I. Nihtyanova None. S. Chatzinikolaou None. V.H. Ong None. C.D. Murray None. C.P. Denton None.