TY - JOUR
T1 - Evaluation of risk factors for pseudo-obstruction in systemic sclerosis
AU - Dein, Eric
AU - Kuo, Pei Lun
AU - Hong, Yun Soo
AU - Hummers, Laura K.
AU - Mecoli, Christopher A.
AU - McMahan, Zsuzsanna H.
N1 - Funding Information:
Portions of the work have been supported by the Rheumatic Diseases Research Core Center (P30-AR053503) Human Subjects Core from the National Institutes of Arthritis Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH). Research reported in this publication was supported by the National Institute of Health under Award Number K23 AR071473. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support for this work is provided by the Scleroderma Research Foundation to ZM. CM and ZM are Jerome L. Greene Foundation Scholars and the Foundation has provided support for their work. LKH received support from The John Staurulakis Endowed Scholar Fund and The Manugian Fund.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/12
Y1 - 2019/12
N2 - Objective: Although up to 90% of systemic sclerosis (SSc) patients are affected by gastrointestinal (GI) dysmotility, the clinical phenotype of patients with pseudo-obstruction is not well-defined. We sought to identify this phenotype by studying a large cohort of SSc patients with and without pseudo-obstruction. Methods: We performed a retrospective analysis of patients seen at the Johns Hopkins Scleroderma Center between February 2003 and September 2017. All SSc patients had clinical data prospectively collected in a longitudinal database. Cross-sectional analyses were performed comparing autoantibody status and clinical and demographic features of patients with and without pseudo-obstruction. Cox proportional hazards regression was used to identify risk factors for pseudo-obstruction. Results: 175 patients with SSc had a history of pseudo-obstruction, and 2,637 SSc patients did not. After adjusting for significant variables from the univariate analysis and potential confounders, the Cox proportional hazards multivariable analysis demonstrated that older age (HR 1.02; 95%CI 1.00–1.04), male sex (HR 1.75; 95%CI 1.42–2.43), diffuse cutaneous disease (HR 2.52; 95%CI 1.59–3.99), myopathy (HR 1.83, 95%CI 1.09–3.08), and opioid use (HR 2.38; 95%CI 1.50–3.78) were predictive of pseudo-obstruction. Autoantibodies to RNA polymerase-3 were negatively associated with pseudo-obstruction (HR 0.34; 95%CI 0.17–0.66). Conclusion: We identified clinical features associated with pseudo-obstruction in a large US SSc cohort. This study identifies characteristics of patients with SSc who are at a higher risk of developing pseudo-obstruction and suggests that opioids may be a modifiable risk factor. These clinical features may allow for earlier diagnostic evaluation and/or therapeutic intervention for patients at risk for pseudo-obstruction.
AB - Objective: Although up to 90% of systemic sclerosis (SSc) patients are affected by gastrointestinal (GI) dysmotility, the clinical phenotype of patients with pseudo-obstruction is not well-defined. We sought to identify this phenotype by studying a large cohort of SSc patients with and without pseudo-obstruction. Methods: We performed a retrospective analysis of patients seen at the Johns Hopkins Scleroderma Center between February 2003 and September 2017. All SSc patients had clinical data prospectively collected in a longitudinal database. Cross-sectional analyses were performed comparing autoantibody status and clinical and demographic features of patients with and without pseudo-obstruction. Cox proportional hazards regression was used to identify risk factors for pseudo-obstruction. Results: 175 patients with SSc had a history of pseudo-obstruction, and 2,637 SSc patients did not. After adjusting for significant variables from the univariate analysis and potential confounders, the Cox proportional hazards multivariable analysis demonstrated that older age (HR 1.02; 95%CI 1.00–1.04), male sex (HR 1.75; 95%CI 1.42–2.43), diffuse cutaneous disease (HR 2.52; 95%CI 1.59–3.99), myopathy (HR 1.83, 95%CI 1.09–3.08), and opioid use (HR 2.38; 95%CI 1.50–3.78) were predictive of pseudo-obstruction. Autoantibodies to RNA polymerase-3 were negatively associated with pseudo-obstruction (HR 0.34; 95%CI 0.17–0.66). Conclusion: We identified clinical features associated with pseudo-obstruction in a large US SSc cohort. This study identifies characteristics of patients with SSc who are at a higher risk of developing pseudo-obstruction and suggests that opioids may be a modifiable risk factor. These clinical features may allow for earlier diagnostic evaluation and/or therapeutic intervention for patients at risk for pseudo-obstruction.
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U2 - 10.1016/j.semarthrit.2019.05.005
DO - 10.1016/j.semarthrit.2019.05.005
M3 - Article
C2 - 31202479
AN - SCOPUS:85067099494
SN - 0049-0172
VL - 49
SP - 405
EP - 410
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
IS - 3
ER -