POS0517 Patient reported gastrointestinal involvement is associated with reduced quality of life and disability in systemic sclerosis

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Background: Impaired quality of life (QoL) in systemic sclerosis (SSc) is multifactorial, including internal organ involvement, fatigue, exertional dyspnoea, decreased work ability, and social participation. Assessing gastrointestinal (GI) tract impairment is complex due to variability in involved organs and non-specific symptoms. Objectives: Investigate the impact of GI involvement in SSc on QoL and SSc related disability using patient-reported outcomes. Methods: Data from 160 consecutive SSc patients (median age 46 years; 55% diffuse cutaneous SSc) were collected, including clinical characteristics, self-assessment questionnaires (PROMs). The severity of GI involvement was determined by University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA-GIT2.0): patients were classified as having ‘none-to-mild' symptoms (total score 0.00-0.49: Group A), ‘moderate' symptoms (total score 0.50-1.00: Group B), and ‘severe-to-very severe' symptoms (total score 1.01-3.00: Group C). All investigations were repeated after one year to check the stability of the results (n=149). Results: QoL (EuroQol-5 Dimension/EQ-5D/ anxiety/depression, Physical Component Summary/PCS/ and Mental Component Summary/MCS/ of Short Form Health Survey-36/SF-36/) and disability questionnaires (Health Assessment Questionnaire Disability Index/HAQ-DI/, Scleroderma HAQ/SHAQ/), Scleroderma Impact of Disease (ScleroID) showed moderate significant correlation with UCLA-GIT2.0 scores (rho:.483, -.481, -.529,.415,.472,.646; respectively). These correlations remained significant when tested in the two main subgroups (lcSSc and dcSSc) (data not shown). Disease duration and UCLA-GIT2 score did not show any correlation (rho:.055, p=0.488). The average GI complaint of the early SSc (<3 years, n=24) subgroup measured by UCLA-GIT2.0 was not different from that of the late group (0.13 (0.03-0.46) vs 0.22 (0.08-0.45), p=0.280). The proportion of B+C group was similar in both the early and late disease stages (21% vs. 24%, p=0.833). The mean disease duration was comparable in group B+C and in group A (group B+C: 9.0 (4.5-15.5) years vs group A: 9.0 (4.0-16.0) years, p=0.513). None of the PROMs (for QoL: EQ-5D anxiety/depression, SF36, ScleroID; for disability: HAQ-DI, SHAQ, SHAQ-GI) showed any significant difference between patients in the early and late phase of the disease (Table 1). Regarding the impact of severe GI complaints on the QoL, all investigated self-assessment questionnaires about QoL and disability showed worse results in patients with moderate gastrointestinal symptoms (Group B) compared with patients with none or mild symptoms (Group A). Similarly, patients with severe gastrointestinal complaints by UCLA-GIT2.0 (Group C) have worse results compared to patients with moderate symptoms (Group B) (Table 2). All QoL and disability-related correlations with the UCLA-GIT2.0 score were confirmed during the one-year follow-up (rho:.240, -.509, -.487,.426,.561,.674; respectively). The differences of SHAQ among patients with severe, moderate or no/mild GI symptoms also remained consistent (SHAQ: 0.18 vs. 1.02 vs. 1.92, p<0.05). Conclusion: Moderate/severe GI symptoms based on UCLA-GIT2.0 are associated with worse QoL, higher anxiety, and disability. This correlation remains valid for both lcSSc and dcSSc subgroups and independent of the disease duration: moderate/severe GI complaints develop early in the SSc parallel with early onset of anxiety, decreased QoL and disability. These results have proven to be consistent over time. REFERENCES: NIL . Table 1Results of the investigated PROMs related to QoL and disability in SSc patients divided into early and late phase of the disease at baseline.VariableDisease duration <36 months (n=24)Disease duration ≥36 months (n=136)median (Q1-Q3)EQ-5D anxiety/depression1.00 (0.00-1.00)0.00 (0.00-1.00)SF-36 Physical component60.0 (29.5-85.5)44.0 (27.3-70.8)SF-36 Mental component71.0 (41.3-80.8)67.5 (40.3-84.0)ScleroID21.0 (6.50-46.3)16.0 (10.0-25.0)HAQ-DI0.25 (0.00-1.38)0.88 (0.13-1.38)SHAQ0.21 (0.00-1.31)0.41 (0.00-1.01)SHAQ-GI0.00 (0.00-0.15)0.03 (0.00-0.62)EuroQol- 5 Dimension; SF-36: Short-Form Health-Survey 36; HAQ-DI: Health Assessment Questionnaire Disability Index; SHAQ: Scleroderma Health Assessment Questionnaire; SHAQ-GI: Scleroderma Health Assessment Questionnaire – visual analogue scale about gastrointestinal involvement; ScleroID: Scleroderma Impact of Disease. There was no significant differences (p>0.05). Table 2Results of the investigated PROMs related to QoL and disability in SSc patients divided based on the UCLA-GIT2.0 scores at baseline.VariableGroup A (n=123)Group B (n=22)Group C (n=15)median (Q1-Q3)EQ-5D mobility0.00 (0.00-1.00)1.00 (0.00-1.00)1.00 (1.00-1.00)EQ-5D self-care0.00 (0.00-0.00)0.00 (0.00-1.00)1.00 (0.00-1.00)EQ-5D activities1.00 (0.00-1.00)1.00 (1.00-1.00)1.00 (1.00-1.00)EQ-5D pain1.00 (0.00-1.00)1.00 (1.00-1.00)1.00 (1.00-2.00)EQ-5D anxiety/depression0.00 (0.00-1.00)1.00 (0.00-1.00)*1.00 (1.00-2.00) # SF-36 Physical component57.0 (35.0-76.5)41.0 (22.5-50.0)*21.0 (17.0-27.0) # SF-36 Mental component72.0 (54.0-86.0)46.5 (33.3-74.8)*24.0 (11.0-37.0) # ScleroID18 (9.0-29.5)33.5 (27.3-41.3)*60.0 (53.0-66.0) # HAQ-DI0.63 (0.00-1.25)1.00 (0.72-1.53)*1.63 (1.13-2.00) # SHAQ0.02 (0.00-0.09)0.07 (0.03-0.14)*0.18 (0.12-0.22) # SHAQ-GI0,00 (0,00-0.02)0.07 (0.01-0.13)*0.15 (0.11-0.25) # *: Significant difference between Group A and Group B with p<0.05. # : Significant difference between Group B and Group C with p<0.05. Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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