Gastrointestinal Symptoms And Rheumatic Diseases: Two Sides Of The Same Coin

Background:Patients with Rheumatic Diseases (RD) often show different symptoms besides the osteoarticular ones. Healthcare workers can evaluate the impact of specific symptoms on RD patients’ quality of life in order to improve global management.Objectives:The aim of this study was to assess the presence of gastrointestinal symptoms in RD patients through Patients Reported Outcomes.Methods:We carried out a cross-sectional study of 101 RD patients compared with 202 healthy volunteers. Healthcare workers invited patients and volunteers to complete questionnaires on gastrointestinal symptoms, through seven domains (belly pain, constipation, diarrhea, disrupted swallowing, gas and bloating, nausea and vomiting, gastroesophageal reflux) of the Patient-Reported Outcomes Measurement Information System (PROMIS®).Results:Among 101 RD patients, 34 (33.6%) had a diagnosis of Rheumatoid Arthritis, 23 (22.7%) had a diagnosis of Psoriatic Arthritis, 12 (11.8%) had axial spondyloarthritis; 18 (17.8%) had Systemic Sclerosis, 8 (7.9%) were classified as Connectivitis (i.e.Lupus, Sjögren Syndrome), and finally 6 (5.9%) had vasculitis. Median disease duration was 7±5 years and just under half (45.5%) of RD patients had active disease according to specific disease activity index. As shown in Table 1, no significant differences were found between patients and controls with regard to demographic and anthropometric characteristics except for sex, since males were 25.7% (n=26) in RD patients and 125 (61,8%) in healthy volunteers. In our study, Patients reported significantly greater gastrointestinal symptoms than healthy controls. More specifically, as shown in Figure 1A, median T score for belly pain, constipation, diarrhea and disrupted swallowing were significantly higher in the RD patients than in healthy controls (50.2 ± 14 vs 41.7 ± 12 p<0.001; 51.5 ± 10 vs 42.2 ± 9 p <0.001; 45.3 ± 8 vs 42 ± 5 p <0.001; 51.1 ± 10 vs 44.6 ± 7 p <0.001) respectively. Moreover, also regarding others domains (gas and bloating, nausea and vomiting and gastroesophageal reflux), patients reported a median T score worse than healthy controls (Figure 1B).Figure 1.Median T Score stratified by study group. Data are shown as mean and standard deviation. The overall p-value was calculated by the Mann–Whitney non-parametric test for independent samples.Conclusion:Firstly, this study highlights the need to investigate further the association between Rheumatic Diseases and gastrointestinal symptoms as potential patterns of underlying diseases and, secondly, the need to adopt validated questionnaires in clinical practice that can help healthcare professionals to detect underestimated symptoms.References:[1]P. T. Kröner, O. A. Tolaymat, A. W. Bowman, A. Abril, e B. E. Lacy, «Gastrointestinal Manifestations of Rheumatological Diseases», Am. J. Gastroenterol., vol. 114, n. 9, pagg. 1441–1454, 2019.[2]J. P. Witter, «The Promise of Patient-Reported Outcomes Measurement Information System-Turning Theory into Reality: A Uniform Approach to Patient-Reported Outcomes Across Rheumatic Diseases», Rheum. Dis. Clin. North Am., vol. 42, n. 2, pagg. 377–394, 2016Table 1.Patients(N= 101)Healthy(N= 202)pDemographic and AnthropometricAge (years)60±1354.2 ±15nsGender n male (%)26 (25,7)125 (61,8)<0,001BMI (Kg/m2)26,4±425,5±4nsSmoke n (%)51(50,5)97(48)nsPhysical Activity (%)27(26,7)62(30,7)nsRheumatoid Arthritis34(33,6)-Psoriatic Arthritis23(22,7)-Spondyloarthritis12(11,8)-Systemic Sclerosis18(17,8)-Connectivitis8(7,9)-Vasculitis6(5,9)-Disease duration (years)7±5-Disease Activity n yes (%)46(45,5)-Medications n (% patients)-NSAID11(10,9)-Steroids26(25,7)-Biological Treatment54(53,5)-Methotrexate34(33,7)-Continuous variables are shown as mean ± standard deviation. Categorical variables are presented as number and proportion. The overall p-value was calculated by the Mann–Whitney non-parametric test for independent samples and by Chi-square test as appropriate.Disclosure of Interests:None declared