CONQUER Scleroderma: association of gastrointestinal tract symptoms in early disease with resource utilization

Sarah Luebker, Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Tracy M. Frech, Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Shervin Assassi, Division of Rheumatology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
Brian Skaug, Division of Rheumatology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
Jessica K. Gordon, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York City, NY, USA.
Kimberly Lakin, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York City, NY, USA.
Elana J. Bernstein, Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA.
Yiming Luo, Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA.
Virginia D. Steen, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
Ami A. Shah, Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Laura K. Hummers, Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Carrie Richardson, Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA.
Duncan F. Moore, Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA.
Dinesh Khanna, Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
Flavia V. Castelino, Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lorinda Chung, Division of Immunology and Rheumatology, Department of Medicine, Stanford University and Palo Alto VA Health Care System, Palo Alto, CA, USA.
Puneet Kapoor, Division of Immunology and Rheumatology, Department of Medicine, Stanford University and Palo Alto VA Health Care System, Palo Alto, CA, USA.
Faye N. Hant, Division of Rheumatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Victoria K. Shanmugam, Department of Anatomy, George Washington University, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
John M. VanBuren, Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Jessica Alvey, Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Monica Harding, Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Ankoor Shah, Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, USA.
Ashima Makol, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Dorota Lebiedz-Odrobina, Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Julie K. Thomas, Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Elizabeth R. Volkmann, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Jerry A. Molitor, Division of Rheumatic and Autoimmune Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Nora Sandorfi, Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Document Type

Journal Article

Publication Date

10-3-2023

Journal

Rheumatology (Oxford, England)

Volume

62

Issue

10

DOI

10.1093/rheumatology/kead176

Keywords

SSc; gastrointestinal tract; health outcomes; health status

Abstract

OBJECTIVES: SSc is associated with increased health-care resource utilization and economic burden. The Collaborative National Quality and Efficacy Registry (CONQUER) is a US-based collaborative that collects longitudinal follow-up data on SSc patients with <5 years of disease duration enrolled at scleroderma centres in the USA. The objective of this study was to investigate the relationship between gastrointestinal tract symptoms and self-reported resource utilization in CONQUER participants. METHODS: CONQUER participants who had completed a baseline and 12-month Gastrointestinal Tract Questionnaire (GIT 2.0) and a Resource Utilization Questionnaire (RUQ) were included in this analysis. Patients were categorized by total GIT 2.0 severity: none-to-mild (0-0.49); moderate (0.50-1.00), and severe-to-very severe (1.01-3.00). Clinical features and medication exposures were examined in each of these categories. The 12-month RUQ responses were summarized by GIT 2.0 score categories at 12 months. RESULTS: Among the 211 CONQUER participants who met the inclusion criteria, most (64%) had mild GIT symptoms, 26% had moderate symptoms, and 10% severe GIT symptoms at 12 months. The categorization of GIT total severity score by RUQ showed that more upper endoscopy procedures and inpatient hospitalization occurred in the CONQUER participants with severe GIT symptoms. These patients with severe GIT symptoms also reported the use of more adaptive equipment. CONCLUSION: This report from the CONQUER cohort suggests that severe GIT symptoms result in more resource utilization. It is especially important to understand resource utilization in early disease cohorts when disease activity, rather than damage, primarily contributes to health-related costs of SSc.

Department

Anatomy and Regenerative Biology

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