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Gastrointestinal involvement and health related quality of life in systemic sclerosis patients
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Introdução: A esclerose sistémica é caracterizada por alterações nos sistemas vascular e imune que levam ao espessamento da pele e a fibrose em múltiplos órgãos. O envolvimento gastrointestinal (GI) é relatado em 90% dos doentes e pode ter um enorme impacto na qualidade de vida (QoL). Contudo, falta evidência sobre quem tem maior probabilidade de o desenvolver e como este afeta a QoL. Objetivos: Comparar a qualidade de vida nos doentes com e sem envolvimento GI (global e particular) e nos subtipos limitado (lcSSc) e difuso (dcSSc) da doença. Caracterizar a prevalência do envolvimento GI e identificar fatores a ele relacionados. Métodos: As características demográficas, clínicas, medicação, exames laboratoriais e questionários de autoavaliação (sintomas GI e QoL) da população em estudo foram obtidos na sua última observação médica. De seguida, foi realizada a análise estatística (análise descritiva e testes não paramétricos). Resultados: Um total de 92 doentes foram incluídos (63.14 anos de média de idade; 93,5% mulheres; 8 anos de duração mediana da doença; 16,3% dcSSc), 80 (87%) apresentavam sintomas GI. Estes tinham características demográficas e clínicas semelhantes às do grupo oposto, excetuando o facto de serem mais velhos aquando da apresentação da doença. Não foram encontradas diferenças entre dcSSc e lcSSc, nem quanto aos parâmetros laboratoriais. O sintoma GI mais prevalente foi o refluxo e doentes com sintomas GI tiveram significativamente pior QoL. Incontinência, diarreia e distensão abdominal tiveram o pior impacto na função social dos doentes. Conclusão: Este estudo suporta a elevada prevalência e impacto dos sintomas gastrointestinais nesta doença. Embora o refluxo seja o mais comum, incontinência, diarreia e distensão foram os que se mostraram mais prejudiciais. Destacamos que questionários podem ajudar a identificar doentes de risco em tempo útil.
Background: Systemic Sclerosis (SSc) is characterized by abnormalities in the vascular and immune systems leading to skin thickening and fibrosis in multiple organs. Gastrointestinal (GI) involvement is reported in 90% of SSc patients and can have an enormous impact on the quality of life (QoL). However, evidence is lacking on which patients are more likely to develop GI symptoms and how individual GI symptoms affect QoL. Objectives: To compare QoL between SSc patients with and without GI involvement, across different GI domains and among limited (lcSSc) and diffuse cutaneous (dcSSc) subtypes. Also, to characterize the prevalence of GI involvement and identify factors related to it. Methods: Cross sectional study of adult patients with SSc registered at Reuma.pt registry. Demographic and disease characteristics, current treatment, laboratory tests and self-assessment questionnaires of GI symptoms and QoL were collected at last observation. Descriptive statistics and nonparametric tests were used. Results: A total of 92 patients were included (63±14 years; 93.5 % female; 8 years of median disease duration, 16.3 % dcSSc), 80 (87%) presented GI symptoms. Except for older age at SSc presentation, patients with GI symptoms had similar demographic and clinical characteristics as those without. Also, no differences were found between dcSSc and lcSSc and regarding laboratory parameters. The most prevalent GI symptom was reflux. SSc patients with GI symptoms had significantly lower QoL assessed by the questionnaires used and reported more fatigue. Soilage, diarrhea and abdominal distension had the worst impact on patient social function. Conclusion: Our work supports the high prevalence and burden of GI symptoms in SSc patients. Although reflux was the most common, soilage, diarrhea and distension were the most detrimental GI symptoms. Self-reported questionnaires can help identify these patients in a timely manner.
Background: Systemic Sclerosis (SSc) is characterized by abnormalities in the vascular and immune systems leading to skin thickening and fibrosis in multiple organs. Gastrointestinal (GI) involvement is reported in 90% of SSc patients and can have an enormous impact on the quality of life (QoL). However, evidence is lacking on which patients are more likely to develop GI symptoms and how individual GI symptoms affect QoL. Objectives: To compare QoL between SSc patients with and without GI involvement, across different GI domains and among limited (lcSSc) and diffuse cutaneous (dcSSc) subtypes. Also, to characterize the prevalence of GI involvement and identify factors related to it. Methods: Cross sectional study of adult patients with SSc registered at Reuma.pt registry. Demographic and disease characteristics, current treatment, laboratory tests and self-assessment questionnaires of GI symptoms and QoL were collected at last observation. Descriptive statistics and nonparametric tests were used. Results: A total of 92 patients were included (63±14 years; 93.5 % female; 8 years of median disease duration, 16.3 % dcSSc), 80 (87%) presented GI symptoms. Except for older age at SSc presentation, patients with GI symptoms had similar demographic and clinical characteristics as those without. Also, no differences were found between dcSSc and lcSSc and regarding laboratory parameters. The most prevalent GI symptom was reflux. SSc patients with GI symptoms had significantly lower QoL assessed by the questionnaires used and reported more fatigue. Soilage, diarrhea and abdominal distension had the worst impact on patient social function. Conclusion: Our work supports the high prevalence and burden of GI symptoms in SSc patients. Although reflux was the most common, soilage, diarrhea and distension were the most detrimental GI symptoms. Self-reported questionnaires can help identify these patients in a timely manner.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Esclerose sistémica Envolvimento gastrointestinal Qualidade de vida Reumatologia