Abstract
SLE can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in >50% of SLE patients. To describe the GI manifestations of SLE in the RELESSER (Registry of SLE Patients of the Spanish Society of Rheumatology) cohort and to determine whether these are associated with a more severe disease, damage accrual and a worse prognosis. We conducted a nationwide, retrospective, multicentre, cross-sectional cohort study of 3658 SLE patients who fulfil ≥4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI (SLICC Damage Index). The presence of oral ulcers reduced the risk of developing damage in 33% of patients. Having GI damage is associated with a worse prognosis. Patients on a high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage.
Highlights
Among the GI manifestations of SLE, nausea, vomiting and anorexia are the most common while abdominal pain, diarrhoea and abdominal distension sometimes presents as symptoms of serious GI involvements, which can result from SLE itself, infections or complications of the treatment [2, 3]
From 3654 SLE patients, 49.3% (n 1⁄4 1691) developed GI symptoms associated with SLE activity, 3.7% (n 1⁄4 131) developed GI damage and 10.2% (n 1⁄4 315) developed other GI manifestations (Table 1)
Hospitalizations and mortality were significantly higher in group 1, suggesting that having GI damage is linked to a worse prognosis
Summary
Gastrointestinal (GI) manifestations are fairly common in patients with SLE and can be the initial presentation of the disease. The prevalence and incidence of GI manifestations varies widely, depending on what symptoms were included in analyses, whether examinations were performed routinely or only in symptomatic patients [1]. Among the GI manifestations of SLE, nausea, vomiting and anorexia are the most common while abdominal pain, diarrhoea and abdominal distension sometimes presents as symptoms of serious GI involvements, which can result from SLE itself, infections or complications of the treatment [2, 3]. Many GI manifestations are not weighted in the SLE Disease Activity Index (SLEDAI) and sometimes may be underestimated [4]. In contrast with other autoimmune diseases, such as systemic sclerosis, GI disease activity is less frequent among patients with SLE. SLE activity involving the GI system can be severe and life threatening
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