Prevalence and Disease‐Specific Risk Factors for Lower Urinary Tract Symptoms in Systemic Sclerosis: An International Multicenter Study

John, Gregor; Avouac, Jérôme; Piantoni, Silvia; Polito, Pamela; Fredi, Micaela; Cozzi, Franco; Airò, Paolo; Truchetet, Marie-Élise; Franceschini, Franco; Allanore, Yannick; Chizzolini, Carlo

doi:10.1002/acr.23454

Cited by 12 publications

(7 citation statements)

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“…Written informed consent has been obtained from all patients included in the study. The following sections summarise our cohort population data, inclusion process and variable management, which have been published previously [ 11 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

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Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study

et al. 2022

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Investigate the natural history of urinary incontinence (UI) in systemic sclerosis (SSc) and assess its impact on quality of life (QoL). A longitudinal, international observational study followed 189 patients with SSc for a median duration of 5 years (IQR: 4.8–5.3). Presence, subtype and severity of UI, hospital admission and QoL were assessed using serial self-administered questionnaires. Mortality data came from national death registries. Multilevel mixed-effect logistic regressions explored factors associated with UI. Cox models adjusted the effects of UI on hospitalization and death for age, sex and subtype of SSc. Mean annual rates of new-onset UI and remission were 16.3% (95%CI 8.3%–24.2%) and 20.8% (95%CI 12.6–29.1), respectively. Among UI patients, 57.9% (95%CI 51.8–64.0) changed from one UI subtype to another. Between annual questionnaires, the severity of UI was the same in 51.1% (95%CI 40.8–61.4), milder or resolved in 35.2% (95%CI 25.3–44.9), and worse in 13.8% (95%CI 6.7–20.9). Anti-centromere antibodies, digestive symptoms, sex, age, neurological or urological comorbidities, diuretics and puffy fingers were all associated with UI. The two strongest predictors of UI and UI subtypes were a recent UI episode and the subtype of previous leakage episodes. UI at inclusion was not associated with hospital admission (adjusted HR: 1.86; 95%CI 0.88–3.93), time to death (aHR: 0.84; 95%CI 0.41–1.73) or change in QoL over time. Self-reported UI among SSc patients is highly dynamic: it waxes and wanes, changing from one subtype to another over time.

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Section: Methodsmentioning

confidence: 99%

“…Other models explored risks by UI subtype and severity (dependent variables). Potential associated factors were chosen based on our previous publications [ 11 , 24 ]. Considering the small sample size and the number of events, we performed exploratory univariate analyses and decided not to perform multivariate analyses.…”

Section: Methodsmentioning

confidence: 99%

Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study

et al. 2022

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“…Thursday, 04 June 2020 411 Background: Lower urinary tract symptoms (LUTS) are an underdiagnosed but frequent manifestation in systemic sclerosis (SSc) [1]. LUTS pathogenesis in SSc is undetermined, mainly involving dysautonomia, fibrosis and a possible antibody-mediated damage [2].…”

Section: Scientific Abstractsmentioning

confidence: 99%

Thu0359 gender Impact on Lower Urinary Tract Involvement in Systemic Sclerosis Patients

et al. 2020

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Background:Lower urinary tract symptoms (LUTS) are an underdiagnosed but frequent manifestation in systemic sclerosis (SSc) [1]. LUTS pathogenesis in SSc is undetermined, mainly involving dysautonomia, fibrosis and a possible antibody-mediated damage [2]. Divergently from general population, female sex and advanced age are not reported to significantly impact LUTS in SSc [2].Objectives:To evaluate the potential influence of gender and hormone-related factors in LUTS prevalence and severity among SSc patients (Pts).Methods:A population of 42 SSc Pts and 50 age- and sex-matched healthy subjects (HSs) was evaluated. SSc diagnosis was based on 2013 ACR/EULAR criteria. Demographic data, medications interfering with pelvic floor dynamics and general comorbidities commonly associated with LUTS – diabetes mellitus, chronic heart failure, chronic obstructive pulmonary disease, peripheral neuropathy, pelvic organ prolapse, fecal incontinence – were recorded. Validated self-reported questionnaires derived from the International Conference on Incontinence were used to assess prevalence and severity of LUTS, namely of urinary incontinence (UI) and overactive bladder (OAB) [3]. Data were analysed using non-parametric tests. Apvalue <0.05 and a confidence interval (CI) of 95% were considered statistically significant.Results:There were no significant differences in main demographic data between SSc Pts and HSs. Specifically, median age was 61 years (IQR 21-85)vs57 years (IQR 28-93) and female prevalence 83%vs84% in SSc PtsvsHSs, respectively. Amongst the female population, 83% of SSc Ptsvs84% of HSs was in post-menopausal state, with a median of 1 (IQR 0-3)vs1 (IQR 0-4) pregnancy by natural route, respectively. No woman of the study had received hormone replacement therapy or local hormonal therapies prior to the study. Similarly, there were not any significant differences in analysed comorbidities, while ongoing treatment was significantly different between the two populations, SSc patients more frequently receiving calcium channel blockers and glucocorticoids than healthy subjects (p< 0.001). In SSc Pts, statistically significant correlation was observed between stress UI and sex, with an increased female-to-male ratio (p< 0.005), but any significant difference was observed in US distribution depending on parity and menopausal state, nor on other analysed variables. Interestingly, female dominance has not resulted as a significant predictive factor for LUTS prevalence or severity in SSc Pts. In fact, in the regression analysis, SSc disease was the only significant predictor for LUTS (OR 3.45, 95% CI 1.41-7.95; p< 0.01), independently of other analysed variables, particularly of gender and hormone-related factors.Conclusion:This study confirms the absence of pathogenic female-gender participation in LUTS prevalence among SSc Pts. However, consistently with findings on general population, a significant increased prevalence of urinary symptoms, particularly of stress UI, in SSc female Pts has emerged [4]. It is therefore conceivable that hormonal factors may act as a catalytic circumstance rather than pathogenic players in LUTS progression during SSc disease.References:[1]John G et al. Arthritis Care Res (Hoboken) 2018;70(8):1218–27.[2]John G. Clin Rheumatol. 2020;39(1):5–8[3]Abrams P et al, J Urol. 2006;175:1063–6[4]Abelson B et al. Biol Sex Differ. 2018;9(1):45Disclosure of Interests:Greta Pacini: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Pietro Francesco Bica: None declared, Elisa Alessandri: None declared, Carmen Pizzorni: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Emanuele Gotelli: None declared, Francesco Cattelan: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha

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“…Background: Lower urinary tract symptoms (LUTS) are a seldom-reported manifestation of systemic sclerosis (SSc). Although LUTS have been described in SSc patients with a higher prevalence than in the general population, no controlled studies have been reported to date [1][2][3]. Objectives: To compare LUTS prevalence and severity in SSc patients and in healthy subjects and mainly to explore their association with SSc clinical and diagnostic parameters.…”

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confidence: 99%

Fri0340 long-Term Follow-Up of Primary Raynaud’s Phenomenon Cohort of 248 Patients

Sanjuán

Bernabéu

Escandell

et al. 2019

Scleroderma, Myositis and Related Syndromes

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BackgroundRaynaud’s phenomenon (RP) is frequently associated with the presence of scleroderma or other connective tissue diseases (CTD). Identify the presence of secondary RP is important to perform an adequate therapeutic management and to achieve the early control of these patients. Nailfold capillaroscopy is safe, economic, easy to perform and has proven to be useful in identifying patients with secondary RP.ObjectivesTo assess a long-term follow-up primary RP patient’s cohort.MethodsRetrospective observational study of a wide and unselected series of patients diagnosed as primary RP from a single university hospital from January 2012 to December 2018. Patients were classified as primary RP after the presence of CTD at the onset was excluded.ResultsWe studied 248 patients (210 women/38 men), with a mean age of 46.3±15.2 years (range 15-88). After a mean follow-up period of 57.2±21.6 months, 9 (3.6%) patients were diagnosed of a CTD. The remaining 239 (96.4%) patients continued classified as primary RP. The main pathologies observed after follow-up were: Scleroderma/Systemic sclerosis (n=3), Systemic Lupus Erythematosus (n=3), Rheumatoid arthritis (n=1), Sjogren’s syndrome (n=2). The main capillaroscopic patterns observed were: Normal (n=175), Unspecific (n=64), Scleroderma pattern (n=3) and suggestive of other rheumatic diseases pattern (n=6). All the patients who developed a CTD during follow-up showed changes at successive nailfold capillaroscopic examinations. 28 of 239 patients who remained primary RP showed minor changes at successive nailfold capillaroscopy. The main capillaroscopic changes detected on this group were: Presence of capillary tortuosity (n=6), presence of a decreased capillary density (2) and the presence of capillary bleeding (n=20). Antinuclear antibodies (ANA) were positive at he onset in 46 patients (16.9%) and after follow-up in 44 (17.7%) patients.ConclusionAfter a mean follow-up period next to 5 years, most of our primary RP patients remained free of CTD. A minority of our patients showed changes at nailfold capillaroscopy exam or positivity of ANA.Disclosure of InterestsNone declared

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Prevalence and Disease‐Specific Risk Factors for Lower Urinary Tract Symptoms in Systemic Sclerosis: An International Multicenter Study

Abstract: Self-reported LUTS are among the most frequent symptoms in SSc and are associated with digestive symptoms. SSc patients with LUTS have lower QoL.

Cited by 12 publications

References 41 publications

Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study

Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study

Thu0359 gender Impact on Lower Urinary Tract Involvement in Systemic Sclerosis Patients

Fri0340 long-Term Follow-Up of Primary Raynaud’s Phenomenon Cohort of 248 Patients

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