Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by progressive fibrosis and connective tissue accumulation affecting the skin and internal organs. Dysphagia is a common clinical manifestation of SSc and is defined by impaired swallowing of food or saliva, which may lead to malnutrition and aspiration pneumonia. It is estimated that approximately 60% of patients with SSc develop dysphagia, primarily due to esophageal smooth muscle dysfunction and fibrotic involvement. Furthermore, dysphagia is strongly associated with greater gastrointestinal involvement, functional impairment, and reduced health-related quality of life.

Objectives: The aim of this study was to characterize self-reported dysphagia in patients with systemic sclerosis and to examine its effects on patient-reported outcome measures, including disease-specific and health-related quality-of-life questionnaires. We further purposed to identify clinical factors associated with the presence of dysphagia.

Methods: This study was designed as a cross-sectional, descriptive, and analytical observational study. Eighty-eight patients with systemic sclerosis were enrolled in the study. Participants completed the Eating Assessment Tool-10 (EAT-10; 0-40), Swallowing Quality of Life (SWAL-QOL; 0-100), UCLA Scleroderma Clinical Trial Consortium GIT 2.0 (UCLA SCTC GIT 2.0; 0-2.83), RAND-36 (0-100), Health Assessment Questionnaire (HAQ; 0-3), and Scleroderma HAQ (SHAQ; 0-100) questionnaires. Patients were subsequently classified into dysphagia and non-dysphagia groups according to an EAT-10 cut-off score of 3.

Results: Patients with SSc were predominantly female (81%) and had a median age of 67 years (IQR: 59–74). The median disease duration was 8 years (IQR: 3–12), with a median symptom duration of 10 years (IQR: 6–19). Limited cutaneous SSc represented the most frequent clinical subtype (57%), whereas diffuse cutaneous disease (21%), unclassified SSc (18%), and SSc sine scleroderma (2.4%) were less common. Skin involvement was the predominant manifestation (52%), followed by gastrointestinal (40%) and pulmonary involvement (33%). Compared with non-dysphagic individuals, patients with dysphagia exhibited significantly lower SWAL-QOL scores (all p <0.001), higher UCLA SCTC GIT 2.0 reflux scores and total scores (both p <0.001), higher HAQ scores (p <0.001), and worse SHAQ gastrointestinal symptom (p =0.003) and general problem scores (p <0.05). In addition, RAND-36 subscales, including Physical Functioning, Bodily Pain, General Health, Social Functioning, Role Limitations due to Emotional Problems, and Mental Health, were significantly impaired in patients with dysphagia (all p <0.05). Multiple linear regression analysis demonstrated that the model significantly explained variations in dysphagia severity (R ² = 0.468, adjusted R ² = 0.411, p < 0.001). UCLA SCTC GIT 2.0 reflux total score was identified as the most significant independent predictor of dysphagia severity (β =0.458, p <0.001). In addition, onset of symptom duration showed a significant association with increased dysphagia severity (β = 0.566, p = 0.022). Age, disease duration, SHAQ gastrointestinal disorders, and SHAQ general problems were not significant predictors in the multivariable model (all p> 0.05).

Conclusions: Dysphagia in patients with SSc is associated with significant reductions in health-related quality of life, particularly across physical, psychological, and social functioning domains. The UCLA SCTC GIT 2.0 reflux total score and onset of symptom duration emerged as the most robust independent predictors of dysphagia severity. These findings underscore the critical role of gastrointestinal involvement in the pathophysiology of dysphagia in patients with SSc. They further emphasize the necessity for comprehensive, multifaceted management strategies that address both gastrointestinal and systemic manifestations to optimize patient outcomes and quality of life.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.