ATLANTA - New research presented this week at ACR Convergence 2022, the American College of Rheumatology’s annual meeting, found no clear association between immunosuppressive or anti-fibrotic medications and worsening gastrointestinal symptoms in early systemic scleroderma (Abstract #1053).
Gastrointestinal tract (GIT) symptoms are among the most common complications in systemic sclerosis (SSc, scleroderma), a disease marked by progressive vasculopathy and fibrosis. Clinicians monitor seven GIT symptoms — reflux, bloating, diarrhea, constipation, fecal incontinence, and emotional and social well-being — using the University of California, Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract Questionnaire (UCLA-GIT 2.0, GIT 2.0), a validated, patient-reported outcome measure. Yet distinguishing disease-related from iatrogenic symptoms can be challenging. This research focused on understanding the relationship of GIT symptoms to medication use.
The study included 399 participants in the Collaborative National Quality and Efficacy Registry (CONQUER) for Scleroderma, a platform that seeks to better understand the development of systemic sclerosis disease in patients less than five years from the first non-Raynaud’s symptom. Patients included had completed at least two serial GIT 2.0 questionaires. They were categorized by total GIT 2.0 severity and further divided into subsets including no change (none-to-mild), improvement in category, worsening in category and no change (moderate-to-severe).
The researchers examined sociodemographics, disease characteristics and medication changes between care visits in each of these categories. Medications were categorized as GIT targeted therapy, anti-fibrotic (nintedanib only) and immunosuppressive or immunomodulatory (hydroxychloroquine only).
The data, examined in May 2022, showed that most participants (n=208 or 52%) had mild stable GIT symptoms. In all categories, reflux medication and immunosuppressives started before the baseline visit while anti-fibrotic medication occurred at or after it. Weight loss, reflux and promotility medications and particularly tobacco use increased the odds of a worse GIT score, but not anti-fibrotic or immunosuppressive drugs.
“It’s surprising that medications commonly blamed for gastrointestinal tract symptoms did not actually result in symptomology,” says Sarah Luebker, DO, a rheumatology fellow at Vanderbilt University Medical Center and the study’s lead author. “The significant odds ratio findings we noted for a worse GIT score include reflux or promotility drugs, but most fascinating is tobacco use, which is significantly associated with severe gastrointestinal tract symptoms. This has never been described before and highlights the value of tobacco cessation education. It may also speak to the value of understanding vasculopathy, which is a focus of the Vanderbilt SSc program.”
Dr. Luebker stresses the importance of early patient referral to SSc Centers of Excellence and encourages junior investigators to partner with CONQUER investigators “to continue to use this valuable platform to further benefit SSc patients.”
About ACR Convergence
ACR Convergence, the annual meeting of the American College of Rheumatology, is where rheumatology meets to collaborate, celebrate, congregate, and learn. With more than 320 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, business education and interactive discussions to improve patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR22).
About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.