Impact of gastrointestinal symptoms and psychological distress on quality of life in systemic sclerosis: a cross-sectional study

Abstract

Motility disorders; Psychological Stress; Quality of Life

Trastornos de la motilidad; Estrés psicológico; Calidad de vida

Trastorns de la motilitat; Estrès psicològic; Qualitat de Vida

Background Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease. Objective To evaluate the impact between gastrointestinal (GI) symptom burden and psychological well-being on HrQoL in patients with SSc. Design Nested cross-sectional study conducted between January and July 2022. Participants A single-centre cohort of 166 patients with SSc, including 103 (55%) with limited cutaneous SSc, 43 (24%) with diffuse SSc and 37 (21%) with sine-sclerosis SSc. Main measures GI symptom burden was assessed using the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0 (UCLA SCTC GIT 2.0) questionnaire, psychological well-being was measured with the Hospital Anxiety and Depression Scale (HADS), and HrQoL was evaluated using the Short Form 36 (SF-36) questionnaire. Demographic, clinical and immunological data were collected from a prospectively maintained database. Key results Patients with moderate to severe GI symptoms (UCLA SCTC GIT 2.0 score >0.5, n=95, 57%) reported decreased HrQoL in all subdomains except vitality by SF-36, and higher anxiety and depression scores by HADS (all p<0.05). The severity of GI symptom burden and depression were independently associated with a decline in the physical component of QoL (β=−0.273 and β=−0.411, respectively, p<0.01 for both). Only the severity of depression and anxiety (β=−0.482 and β=−0.213, respectively, p<0.05), but not GI symptom burden, were independently associated with a decline in the mental component of QoL. Conclusions Our data suggest that in patients with SSc, GI and psychological burden negatively influence quality of life independently, highlighting the need for a holistic approach to patient’s care.

This work was supported by the Instituto de Salud Carlos III and co-financed by the European Union (FEDER/FSE) [PI22/01804; Ciberehd is funded by the Instituto de Salud Carlos III. LA was supported by Grant from the neurogastroenterology and motility workgroup of the Spanish Association of Gastroenterology (AEG) (Recipient March 2023). This work was supported by a voucher (Q123RSV79) from the European Alliance of Associations for Rheumatology (EULAR). The content is solely the responsibility of the authors and does not necessarily represent the official views of EULAR.