{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:01:05Z","timestamp":1792735265138,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,8,6]],"date-time":"2018-08-06T00:00:00Z","timestamp":1533513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001845","name":"Scleroderma Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001845","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>A subset of patients with systemic sclerosis (<jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c) develop severe gastrointestinal (<jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content>) dysmotility. We sought to determine predictors of severe <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysmotility and to identify distinct features associated with this phenotype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c who required supplemental nutrition (enteral or parenteral tube feeding) were compared to <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c patients with mild <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> symptoms in a cross\u2010sectional analysis. The association between severe <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysmotility and clinical and serologic features was examined using logistic regression. Baseline data were examined to determine predictors of developing severe <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysfunction using Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c patients with severe <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysmotility (n = 66) were more likely than those patients with mild <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> symptoms (n = 1,736) to be male (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 2.47 [95% confidence interval (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 1.34\u20134.56]; <jats:italic>P<\/jats:italic> = 0.004), and to have myopathy (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 5.53 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.82\u201310.82]; <jats:italic>P<\/jats:italic> &lt; 0.001), and sicca symptoms (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.40 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.30\u20134.42]; <jats:italic>P<\/jats:italic> = 0.005), even after adjustment for potential confounders. Baseline features that were associated with the future development of severe <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysfunction included male sex (hazard ratio [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>] 2.99 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.53\u20135.84]; <jats:italic>P<\/jats:italic> = 0.001) and myopathy (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 5.08 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.21\u201311.67]; <jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Distinct clinical features are present in <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c patients who are at risk of developing severe <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> dysmotility. This finding is not only important clinically but also suggests that a unique pathologic process is at work in these patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23479","type":"journal-article","created":{"date-parts":[[2017,11,29]],"date-time":"2017-11-29T12:13:49Z","timestamp":1511957629000},"page":"1385-1392","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis"],"prefix":"10.1002","volume":"70","author":[{"given":"Zsuzsanna H.","family":"McMahan","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie J.","family":"Paik","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick M.","family":"Wigley","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura K.","family":"Hummers","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-011-0217-3"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2004.08.009"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200011)43:11<2437::AID-ANR10>3.0.CO;2-U"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2015.04.007"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev393"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38098"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230510"},{"key":"e_1_2_7_9_1","first-page":"1573","article-title":"Criteria for the classification of early systemic sclerosis","volume":"28","author":"LeRoy EC","year":"2001","journal-title":"J Rheumatol"},{"key":"e_1_2_7_10_1","first-page":"2159","article-title":"A disease severity scale for systemic sclerosis: development and testing","volume":"26","author":"Medsger TA","year":"1999","journal-title":"J Rheumatol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9712108"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/arrd.1987.135.4.805"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39316"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.096545"},{"key":"e_1_2_7_15_1","first-page":"2050","article-title":"Characteristics of patients with early systemic sclerosis and severe gastrointestinal tract involvement","volume":"34","author":"Nishimagi E","year":"2007","journal-title":"J Rheumatol"},{"key":"e_1_2_7_16_1","first-page":"41","article-title":"Ultrastructure of the small intestinal mucosa in progressive systemic sclerosis (PSS)","volume":"95","author":"Hendel L","year":"1987","journal-title":"Acta Pathol Microbiol Immunol Scand A"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.086074"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1756-185X.2012.01810.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21922"},{"key":"e_1_2_7_20_1","first-page":"965","article-title":"Sj\u00f6gren's syndrome in progressive systemic sclerosis","volume":"15","author":"Drosos AA","year":"1988","journal-title":"J Rheumatol"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.3109\/03009749009092622"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2013.05.002"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/36.6.669"}],"container-title":["Arthritis Care &amp; 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