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Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis
Author(s) -
McMahan Zsuzsanna H.,
Paik Julie J.,
Wigley Fredrick M.,
Hummers Laura K.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23479
Subject(s) - medicine , gastroenterology , odds ratio , hazard ratio , confidence interval , confounding , myopathy , proportional hazards model , logistic regression
Objective A subset of patients with systemic sclerosis ( SS c) develop severe gastrointestinal ( GI ) dysmotility. We sought to determine predictors of severe SS c GI dysmotility and to identify distinct features associated with this phenotype. Methods Patients with SS c who required supplemental nutrition (enteral or parenteral tube feeding) were compared to SS c patients with mild GI symptoms in a cross‐sectional analysis. The association between severe GI dysmotility and clinical and serologic features was examined using logistic regression. Baseline data were examined to determine predictors of developing severe GI dysfunction using Cox regression. Results SS c patients with severe GI dysmotility (n = 66) were more likely than those patients with mild GI symptoms (n = 1,736) to be male (odds ratio [ OR ] 2.47 [95% confidence interval (95% CI ) 1.34–4.56]; P = 0.004), and to have myopathy ( OR 5.53 [95% CI 2.82–10.82]; P < 0.001), and sicca symptoms ( OR 2.40 [95% CI 1.30–4.42]; P = 0.005), even after adjustment for potential confounders. Baseline features that were associated with the future development of severe GI dysfunction included male sex (hazard ratio [ HR ] 2.99 [95% CI 1.53–5.84]; P = 0.001) and myopathy ( HR 5.08 [95% CI 2.21–11.67]; P < 0.001). Conclusion Distinct clinical features are present in SS c patients who are at risk of developing severe GI dysmotility. This finding is not only important clinically but also suggests that a unique pathologic process is at work in these patients.