The validity and reliability study of the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT) 2.0 questionnaire for the Turkish society

Creation and Validation of a Portuguese Version of the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument

(1) Background: The UCLA GIT 2.0 questionnaire has been recognized as a feasible and reliable instrument to assess gastrointestinal (GI) symptoms in systemic sclerosis (SSc) patients and their impact on quality of life. The aim of this study was to create and validate UCLA GIT 2.0 for Portuguese patients with SSc. (2) Methods: A multi-center study was conducted enrolling SSc patients. UCLA GIT 2.0 was validated in Portuguese using reliability (internal consistency, item -total correlation, and reproducibility) and validity (content, construct, and criterion) tests. Criterion tests included EQ-5D and SF-36v2. Social-demographic and clinical data were collected. (3) Results: 102 SSc patients were included, 82.4% of them female, and with a mean sample age of 57.0 ± 12.5 years old. The limited form of SSc was present in 62% of the patients and 56.9% had fewer than five years of disease duration. Almost 60% presented with SSc-GI involvement with a negative impact on quality of life. The means for SF-36v2 were 39.3 ± 10.3 in the physical component summary and 47.5 ± 12.1 in the mental component summary. Total GI score, reported as mild in 57.8% of the patients, was highly reliable (ICC = 0.912) and the Cronbach's alpha was 0.954. There was a high correlation between the total GI score and EQ-5D-5L and SF-36v2 scores. (4) Conclusion: The Portuguese version of UCLA GIT 2.0 showed good psychometric properties and can be used in research and clinical practice.

Reliability and validity of the Korean version of the University of California-Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract instrument in patients with systemic sclerosis

BACKGROUND/AIMS

Systemic sclerosis (SSc) is associated with a wide range of gastrointestinal (GI) changes. The University of California-Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT 2.0) instrument is a self-administered GI assessment instrument for patients with SSc. We developed a Korean version of the UCLA SCTC GIT 2.0 instrument and evaluated its reliability and internal consistency.

METHODS

The participants were 37 Korean patients with SSc. Translation and cross-cultural adaptation of the UCLA SCTC GIT 2.0 were performed according to international standardized guidelines. We evaluated reproducibility by calculating the intraclass correlation coefficients and assessed the internal consistency of the Korean version of the UCLA SCTC GIT 2.0. We assessed its construct validity by evaluating its correlations with the Short Form Health Survey version 2 and EQ-5D scores by means of Spearman correlation analyses.

RESULTS

Patients with SSc were mostly women (89.19%) with a mean age of 52.2 years, median disease duration of 24 months, and median modified Rodnan total skin score of 4. The median total GIT score on the UCLA SCTC GIT 2.0 was 0.3. The UCLA SCTC GIT 2.0 Korean version showed excellent internal consistency (Cronbach's α of total GIT score = 0.863). Most domains of the ULCA SCTC GIT 2.0 were correlated with those of the EuroQol (EQ)-5D score.

CONCLUSION

The Korean version of the UCLA SCTC GIT 2.0 has acceptable internal consistency, reliability, and validity. Therefore, it can be used to assess GIT involvement in Korean patients with SSc.

Performance of the UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 instrument as a clinical decision aid in the routine clinical care of patients with systemic sclerosis

BACKGROUND AND OBJECTIVES

The University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) is validated to capture gastrointestinal (GI) tract morbidity in patients with systemic sclerosis (SSc). The aims of this study were to determine in a large SSc cohort if the UCLA GIT 2.0 is able to discriminate patients for whom a rheumatologist with experience in SSc would recommend an esophago-gastro-duodenoscopy (EGD), and if it could identify patients with endoscopically proven esophagitis or with any pathologic finding on EGD.

METHODS

We selected patients fulfilling the ACR/EULAR 2013 criteria for SSc from our EUSTAR center having completed at least once the UCLA GIT 2.0 questionnaire, and we collected data on gastrointestinal symptoms and EGD from their medical charts. We analyzed by general linear mixed effect models several parameters, including UCLA GIT 2.0, considered as potentially associated with the indication of EGD, as well as with endoscopic esophagitis and any pathologic finding on EGD.

RESULTS

We identified 346 patients (82.7% female, median age 63 years, median disease duration 10 years, 23% diffuse cutaneous SSc) satisfying the inclusion criteria, who completed UCLA GIT 2.0 questionnaires at 940 visits. EGD was recommended at 169 visits. In multivariable analysis, UCLA GIT 2.0 and some of its subscales (reflux, distention/bloating, social functioning) were associated with the indication of EGD. In 177 EGD performed in 145 patients, neither the total ULCA GIT 2.0 score nor any of its subscales were associated with endoscopic esophagitis, nor with any pathologic EGD findings.

CONCLUSIONS

In a real-life setting, the UCLA GIT 2.0 and its reflux subscale were able to discriminate patients with SSc who had an indication for EGD, but did not correlate with findings in EGD. We conclude that, while using the UCLA GIT 2.0 in the routine care of patients with SSc may help the rheumatologist to better understand the burden of GI symptoms in the individual patient, it should not be used as a stand-alone instrument to identify an indication of EGD.

Evaluating skeletal muscle mass with ultrasound in patients with systemic sclerosis

OBJECTIVES

Patients with systemic sclerosis (SSc) have an increased risk for loss of skeletal muscle mass. Ultrasonography (US) is a safe and promising method to evaluate muscle mass. In this study, we aimed to assess the frequency and clinical associations of low muscle mass status in patients with SSc, investigate the correlations between muscle mass sonographically measured regional muscle thicknesses (MTs), and explore the utility of US in predicting low muscle mass.

METHODS

A total of 93 patients with SSc (86 women) were included in the study. Appendicular skeletal muscle mass (ASM) was calculated using a bioelectric impedance analysis and adjusted for height² (ASM index, ASMI). Low muscle mass was defined as an ASMI of <7.26 kg/m² for men and <5.50 kg/m² for women. MT of the gastrocnemius medialis (GM), rectus femoris (RF), rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TA) muscles were assessed by US. Correlations between ASMI and individual MTs were evaluated. Receiver operating characteristic analysis was used to determine the optimal cutoff values of MTs in predicting low muscle mass.

RESULTS

Low muscle mass was present in 13.9% of patients. Diffuse disease subset (53.8% vs 17.5%), antitopoisomerase-1 antibody positivity (76.9% vs 47.5%), and malnutrition (61.5% vs 8.8%) were more frequent in patients with low muscle mass (P < 0.05 for all). MTs of RA (0.54 vs 0.75 cm), TA (0.30 vs 0.34 cm), and GM (1.23 vs 1.51 cm) muscles were significantly lower in patients with low muscle mass (P < 0.05 for all). RA (r = 0.322; P = 0.002), external oblique (r = 0.310; P = 0.002), TA (r = 0.205; P = 0.049), and GM (r = 0.513; P < 0.001) MTs were positively correlated with ASMI. Selected cutoff values for GM and RA MTs showed the highest sensitivity (92.3% for both) and negative predictive value (97.9% and 97.6%, respectively) in predicting low muscle mass status (area under the curve: 0.846 and 0.760, respectively) in the receiver operating characteristic analysis.

CONCLUSIONS

Low muscle mass is prevalent in SSc and patients with diffuse disease are at particular risk for this condition. US measurement of abdominal and calf MTs may be used as a screening method to detect low muscle mass due to its high sensitivity and negative predictive value.