The aim of this study was to evaluate the body composition (BC), bone mineral density (BMD), and the food intake in women with systemic sclerosis (SSc) compared to a control group, in order to identify main risk factors for BC abnormalities in SSc. Sixty-one SSc women and 67 age- and gender-matched controls were included. Spine, femur, and total body BMD measurements were performed using dual-energy X-ray absorptiometry. BC measurements included total lean (LM), fat mass (FM), and relative skeletal muscle mass index (RSMI) assessment. The food intake was calculated from 3-day food records and transformed into energy and nutrients. The 61 SSc patients [30 with diffuse cutaneous disease (dcSSc) and 31 with limited cutaneous SSc (lcSSc)] had significantly lower body mass index (BMI), LM, and FM, as well as lower BMD values compared to controls. Besides, the group with dcSSc, but not those with lcSSc, showed significantly lower BC and BMD measurements than controls. There was a significant inverse correlation between disease duration and BMI, LM, and RSMI. The total energy, macronutrients, and essential amino acids intakes were similar between patients and controls. After multivariate analysis, longer disease duration was the only risk factor associated with sarcopenia (RSMI below 5.45 kg/m(2); OR = 1.36, 95% CI 1.07-1.7). The present study showed an abnormal BC and a lower BMD, especially in dcSSc women, regardless of current food intake. Longer disease duration was associated with a higher risk of sarcopenia in SSc patients.
Objectives Changes in the intestinal microbiota have been associated with the pathogenesis of SSc. Probiotics act by modulating the microbiome and the immune response. This study aimed to evaluate the efficacy of probiotics on gastrointestinal (GI) symptoms and immune responses in SSc patients. Methods Patients with SSc with a moderate–severe total score on the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA GIT 2.0) instrument were randomly assigned to receive a daily dose of probiotics (Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophillus and Bifidobacterium lactis, 109 colony-forming units per capsule) or placebo for 8 weeks. The primary endpoint was improvement in the UCLA GIT 2.0 total score after 8 weeks. Secondary outcomes included changes in Th1, Th2, Th17 and regulatory T cell circulating levels and in the HAQ Disability Index (HAQ-DI) score. Parameters were assessed at baseline and after 4 and 8 weeks of treatment. Results A total of 73 patients were randomized to receive probiotics (n = 37) or placebo (n = 36). After 8 weeks, there was no difference in the UCLA GIT 2.0 score between the two groups. At week 8, the probiotic group showed a significant decrease in the proportion of Th17 cells compared with placebo (P = 0.003). There was no difference in the proportion of Th1, Th2 and regulatory T cells or in the HAQ-DI score between the groups. Conclusion Probiotics did not improve GI symptoms in SSc patients. The reduction in Th17 cell levels suggests an immunomodulatory effect of probiotics on SSc. Trial registration ClinicalTrials.gov (http://clinicaltrials.gov), NCT 02302352.
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