POS1316 PATIENT REPORTED GASTROINTESTINAL INVOLVEMENT IS ASSOCIATED WITH DECREASED CAPILLARY DENSITY AND REDUCED QUALITY OF LIFE IN SYSTEMIC SCLEROSIS

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Background Gastrointestinal (GI) tract involvement is one of the major contributors to decreased quality of life (QoL) in patients with systemic sclerosis (SSc). University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA-GIT2) is the most frequently used patient reported survey for GI involvement, with limited data about its relation to QoL. Objectives To investigate the role of GI involvement of SSc in relations of QoL with different non-invasive methods, i.e. patient-reported outcome measurements, nailfold capillaroscopy (NCM). Methods Data of 160 consecutive SSc patients (median age 46 (43;56) years; diffuse cutaneous SSc 55%) including clinical characteristics, a set of self-assessment questionnaires and capillaroscopic findings were collected. Results All investigated self-assessment questionnaires about QoL (EuroQol- 5 Dimension/EQ-5D/, the Physical Component Summary/PCS/ and the Mental Component Summary/MCS/ of Short Form Health-Survey – 36/SF-36/) and disability (Health Assessment Questionnaire Disability Index/HAQ-DI/, Scleroderma HAQ/SHAQ/) correlated moderately with the UCLA-GIT2 score (rho:.477, -.485, -.468,.401, and.437, respectively). Patients with moderate and severe GI complaints based on the UCLA-GIT2 had significantly worse QoL compared to patients with no or mild GI symptoms (i.e. median EQ-5D in patients with severe vs. moderate vs. no or mild symptoms: 0.45 (0.20-0.80) vs. 0.80 (0.60-0.95) vs. 1.00 (0.80-1.20), respectively, p<0.05). The results were similar with regard to disability (SHAQ in patients with severe vs. moderate vs. no or mild symptoms: 0.18 (0.12-0.21) vs. 0.07 (0.04-0.13) vs.0.02 (0.00-0.09), respectively, p<0.05). The association between different disease activity scores and the UCLA-GIT2 were very low and additionally inconsequent in different disease subgroups. Capillary density (CD) by NCM correlated weakly but significantly with UCLA-GIT2 (rho:.224, p=0.006) and EQ-5D (rho:.182, p=0.025). A slightly stronger correlation was found between CD and the anxiety item of EQ-5D (rho:.250, p=0.002). The value of 5.8 capillaries/mm was the best cut off for differentiating patients with no or mild and moderate to severe GI symptoms by ROC curve analysis (AUC: 0.672). Patients with this pronounced capillary rarefaction (≤6 capillaries/mm) showed higher prevalence of pronounced GI symptoms (moderate or severe UCLA-GIT2 score) and higher anxiety (by EQ-5D) than patients with higher CD (UCLA-GIT2: 88% vs 31%, p<0.0001; EQ-5D-anxiety: 0.0 (0.0-1.0) vs. 1.0 (0.0-1.0), p=0.015). We found a moderate negative correlation between capillary density and disease damage index (SCTC-DI – rho: -.365, p<0.0001). Conclusion Our results demonstrated, that moderate or severe GI symptoms based on the UCLA-GIT2 correlated with worse QoL, higher anxiety and disability. A cut off of ≤6 capillaries/mm on NCM clearly differentiated SSc patients with no or mild GI complaints from those with more prominent symptoms. This very low CD also distinguished patients with pronounced anxiety and without it. Decreased capillary density by NCM could reflect worse microcirculation in the GI tract leading to more pronounced GI symptoms. Reference [1]Autoimmun Rev. 2020 Mar;19(3):102458. doi: 10.1016/j.autrev.2020.102458. Acknowledgements Project TKP-2021-EGA-10 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under scheme. Disclosure of Interests None Declared.

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