Patients with more severe reflux in systemic sclerosis have worse lung outcomes
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Patients with systemic sclerosis who report more severe reflux symptoms demonstrate worse interstitial lung disease outcomes despite receiving standard therapy, according to data published in Arthritis Care & Research.
“Predicting which patients are likely to experience progressive pulmonary fibrosis is a challenge in systemic sclerosis,” Elizabeth R. Volkmann, MD, MS, director of the scleroderma program at the University of California Los Angeles, told Healio. “The motivation for this study was to understand whether the severity of esophageal involvement contributes to progressive pulmonary fibrosis in this disease.”
To investigate the connection between gastrointestinal reflux symptoms and the radiographical progression of SSc-associated interstitial lung disease, Volkmann and colleagues conducted SLS II, a multicenter, randomized controlled trial. The study included adults with SSc aged 18 years or older with a disease duration of 7 years or less. Patients were excluded from the study if they had pulmonary hypertension requiring therapy, reported smoking within the previous 6 months, had evidence of an airway obstruction or demonstrated clinically significant abnormalities on high-resolution computerized tomography that was not attributable to SSc.
Included patients were randomized to be treated with oral cyclophosphamide for 1 year, followed by 1 year of placebo, or 2 years of mycophenolate. The study’s primary endpoint was forced vital capacity percentage, as measured every 3 months over 3 years. A secondary endpoint was the change in fibrosis as measured by a radiograph at 2 years. The researchers used the UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 to measure the severity of disease symptoms at baseline.
The analysis included 141 patients with an average patient-reported reflux score of 0.57 at baseline. Reflux scores at baseline were “significantly associated” with changes in the maximum involvement of radiographic fibrosis and interstitial lung disease. Additionally, radiographic esophageal measures were not associated with changes in lung involvement measures, according to the researchers.
“Asking patients about their reflux symptoms not only helps you understand the severity of their gastrointestinal tract involvement related to systemic sclerosis, but it may also help you risk stratify patients with interstitial lung disease,” Volkmann said. “Patients who reported more severe symptoms of reflux had worse outcomes in terms of their interstitial lung disease, despite receiving standard therapy for interstitial lung disease in a clinical trial.
“Optimizing the treatment of gastroesophageal reflux disease may improve outcomes for patients with systemic sclerosis related interstitial lung disease,” she added. “More research is needed to determine whether some of our new agents for managing reflux disease — for example, promotility agents — could reduce aspiration events related to reflux disease and limit progression of interstitial lung disease.”
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