Background: Dysphagia is a clinically significant yet frequently underrecognized manifestation of idiopathic inflammatory myopathies (IIM), with a disease course that may be chronically progressive, exhibit relapsing–remitting patterns, or improve by immunosuppressive treatment. Importantly, swallowing dysfunction is not confined to advanced disease stages and may present early in the disease course or even as an isolated symptom, underscoring its diagnostic relevance in patients with otherwise unexplained dysphagia.

Objectives: This study aimed to evaluate the prevalence and clinical impact of self-reported dysphagia across adult myositis subtypes and to identify factors associated with dysphagia severity.

Methods: A total of 168 patients with IIM were included in the study. All participants completed the Eating Assessment Tool–10 (EAT-10) to screen for swallowing difficulties, as well as the Swallowing Quality of Life questionnaire (SWAL-QOL) and the RAND-36 Health Survey to assess swallowing-related and health-related quality of life. Dysphagia was defined using an established EAT-10 cut-off score of ≥3; accordingly, patients were categorized into dysphagia (EAT-10 ≥3) and non-dysphagia (EAT-10 <3) groups.

Results: The myositis cohort consisted predominantly of female patients (56.2%), with a mean age of 67.4 ± 13.2 years. The median time to symptom onset was 6 years (IQR: 3.75–11), and the median disease duration was 4.5 years (IQR: 2–9). According to the EULAR/ACR classification criteria, dermatomyositis (28%), antisynthetase syndrome (28%), and polymyositis (19.6%) were the most frequent subtypes, followed by inclusion body myositis (IBM) (10.1%), amyopathic dermatomyositis (1.8%), and immune-mediated necrotizing myopathy (8.9%). Based on the EAT-10 scale, dysphagia prevalence varied across myositis subtypes and was particularly high in patients with IBM, affecting 64.7% of this subgroup, compared with 36.4% in polymyositis and 19.1% in dermatomyositis. Compared with patients with EAT-10 scores <3, those with dysphagia (EAT-10≥3) had significantly poorer swallowing-related quality of life across all SWAL-QOL domains (all p<0.001). Dysphagic patients also demonstrated significantly lower RAND-36 scores in all domains, with the exception of bodily pain, which did not differ between groups (p = 0.156). In the multivariable binary logistic regression analysis, dysphagia severity emerged as a significant predictor, with both mild dysphagia (OR= 3.67, 95% CI: 1.60–8.40, p= 0.002) and moderate-to-severe dysphagia (OR= 3.24, 95% CI: 1.03–10.24, p= 0.045) being independently associated with an increased risk of dysphagia. However, age, sex, symptom onset, disease duration, and gastrointestinal disease activity were not significantly associated with the risk of dysphagia (all p>0.05).

Conclusions: Dysphagia is a frequent and clinically relevant manifestation in patients with myositis, with a particularly high prevalence observed in patients with IBM. The presence of dysphagia is associated with markedly impaired swallowing-related quality of life and reduced health-related quality of life, as reflected by SWAL-QOL and RAND-36 scores. While demographic and disease-related variables were not independently associated with dysphagia, dysphagia severity emerged as a significant predictor, underscoring the clinical utility of the EAT-10 in identifying patients at increased risk. These findings highlight the importance of routine assessment of swallowing dysfunction in myositis, particularly in high-risk subgroups such as patients with IBM, to facilitate early intervention and multidisciplinary management.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.