{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:08:22Z","timestamp":1791828502904,"version":"4.3.4"},"reference-count":30,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Spanish Association of Gastroenterology (AEG), neurogastroenterology and motility group","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]},{"name":"European Alliance of Associations for Rheumatology","award":["Q123RSV79"],"award-info":[{"award-number":["Q123RSV79"]}]},{"name":"Instituto de Salud Carlos III and co-financed by the European Union","award":["PI22\/01804"],"award-info":[{"award-number":["PI22\/01804"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,8]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact between gastrointestinal (GI) symptom burden and psychological well-being on HrQoL in patients with SSc.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nested cross-sectional study conducted between January and July 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A single-centre cohort of 166 patients with SSc, including 103 (55%) with limited cutaneous SSc, 43 (24%) with diffuse SSc and 37 (21%) with sine-sclerosis SSc.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main measures<\/jats:title>\n                    <jats:p>GI symptom burden was assessed using the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0 (UCLA SCTC GIT 2.0) questionnaire, psychological well-being was measured with the Hospital Anxiety and Depression Scale (HADS), and HrQoL was evaluated using the Short Form 36 (SF-36) questionnaire. Demographic, clinical and immunological data were collected from a prospectively maintained database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key results<\/jats:title>\n                    <jats:p>Patients with moderate to severe GI symptoms (UCLA SCTC GIT 2.0 score &gt;0.5, n=95, 57%) reported decreased HrQoL in all subdomains except vitality by SF-36, and higher anxiety and depression scores by HADS (all p&lt;0.05). The severity of GI symptom burden and depression were independently associated with a decline in the physical component of QoL (\u03b2=\u22120.273\u2009and \u03b2=\u22120.411, respectively, p&lt;0.01 for both). Only the severity of depression and anxiety (\u03b2=\u22120.482\u2009and \u03b2=\u22120.213, respectively, p&lt;0.05), but not GI symptom burden, were independently associated with a decline in the mental component of QoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our data suggest that in patients with SSc, GI and psychological burden negatively influence quality of life independently, highlighting the need for a holistic approach to patient\u2019s care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-089725","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T04:32:20Z","timestamp":1732768340000},"page":"e089725","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Impact of gastrointestinal symptoms and psychological distress on quality of life in systemic sclerosis: a cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3247-1539","authenticated-orcid":false,"given":"Luis Gerardo","family":"Alcala-Gonzalez","sequence":"first","affiliation":[{"name":"Digestive System Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0626-507X","authenticated-orcid":false,"given":"Alfredo","family":"Guillen-Del-Castillo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariadna","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Barber","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Codina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Marin Garcia","sequence":"additional","affiliation":[{"name":"Department of Digestive Diseases, Vall d\u2019Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Malagelada","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen P","family":"Simeon-Aznar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Systemic Autoimmune Diseases Unit, Vall d\u2019Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"2025121511355333000_14.11.e089725.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01692-0"},{"key":"2025121511355333000_14.11.e089725.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-022-00900-6"},{"key":"2025121511355333000_14.11.e089725.3","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.rdc.2023.01.006","article-title":"Gastrointestinal Tract Considerations Part I: How Should a Rheumatologist Best Manage Common Upper Gastrointestinal Tract Complaints in Systemic Sclerosis?","volume":"49","author":"Quinlivan","year":"2023","journal-title":"Rheum Dis Clin North Am"},{"key":"2025121511355333000_14.11.e089725.4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.rdc.2023.01.007","article-title":"Gastrointestinal Tract Considerations: Part II: How Should a Rheumatologist Best Manage Common Lower Gastrointestinal Tract Complaints in Systemic Sclerosis?","volume":"49","author":"Quinlivan","year":"2023","journal-title":"Rheum Dis Clin North Am"},{"key":"2025121511355333000_14.11.e089725.5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/23971983221086343","article-title":"Management of scleroderma gastrointestinal disease: Lights and shadows","volume":"7","author":"Cheah","year":"2022","journal-title":"J Scleroderma Relat Disord"},{"key":"2025121511355333000_14.11.e089725.6","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24411"},{"key":"2025121511355333000_14.11.e089725.7","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/j.autrev.2017.09.010","article-title":"Humanistic and cost burden of systemic sclerosis: A review of the literature","volume":"16","author":"Fischer","year":"2017","journal-title":"Autoimmun Rev"},{"key":"2025121511355333000_14.11.e089725.8","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.autrev.2015.07.012","article-title":"Quality of life in systemic sclerosis","volume":"14","author":"Almeida","year":"2015","journal-title":"Autoimmun Rev"},{"key":"2025121511355333000_14.11.e089725.9","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.semarthrit.2016.02.005","article-title":"Impaired quality of life in systemic sclerosis and patient perception of the disease: A large international survey","volume":"46","author":"Frantz","year":"2016","journal-title":"Semin Arthritis Rheum"},{"key":"2025121511355333000_14.11.e089725.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.22910"},{"key":"2025121511355333000_14.11.e089725.11","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/rheumatology\/keq296","article-title":"Association of gastrointestinal involvement and depressive symptoms in patients with systemic sclerosis","volume":"50","author":"Bodukam","year":"2011","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.12","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204424"},{"key":"2025121511355333000_14.11.e089725.13","first-page":"202","article-title":"Scleroderma (systemic sclerosis): classification, subsets and pathogenesis","volume":"15","author":"LeRoy","year":"1988","journal-title":"J Rheumatol"},{"key":"2025121511355333000_14.11.e089725.14","doi-asserted-by":"crossref","first-page":"34","DOI":"10.55563\/clinexprheumatol\/qo1ehz","article-title":"The Hospital Anxiety and Depression Scale in patients with systemic sclerosis: a psychometric and factor analysis in a monocentric cohort","volume":"39 Suppl 131","author":"Garaiman","year":"2021","journal-title":"Clin Exp Rheumatol"},{"key":"2025121511355333000_14.11.e089725.15","unstructured":"Alonso J , Regidor E , Barrio G , et al . Population reference values of the Spanish version of the Health Questionnaire SF-36. 1998;111:410\u20136."},{"key":"2025121511355333000_14.11.e089725.16","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/33.12.1117"},{"key":"2025121511355333000_14.11.e089725.17","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1093\/rheumatology\/keab279","article-title":"Anti-RNPC-3 antibody predicts poor prognosis in patients with interstitial lung disease associated to systemic sclerosis","volume":"61","author":"Callejas-Moraga","year":"2021","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.18","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1093\/rheumatology\/kead520","article-title":"Anti-nuclear valosin-containing protein-like autoantibody is associated with calcinosis and higher risk of cancer in systemic sclerosis","volume":"63","author":"Perurena-Prieto","year":"2024","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.19","first-page":"155","article-title":"Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis","volume":"27","author":"Cutolo","year":"2000","journal-title":"J Rheumatol"},{"key":"2025121511355333000_14.11.e089725.20","doi-asserted-by":"publisher","DOI":"10.1002\/art.24676"},{"key":"2025121511355333000_14.11.e089725.21","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1093\/rheumatology\/keq147","article-title":"Assessment of gastrointestinal symptoms in patients with systemic sclerosis in a UK tertiary referral centre","volume":"49","author":"Thoua","year":"2010","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-083419","article-title":"Severity and impact of digestive impairment perceived by patients with systemic sclerosis: a cross-sectional study","volume":"14","author":"Cano-Garc\u00eda","year":"2024","journal-title":"BMJ Open"},{"key":"2025121511355333000_14.11.e089725.23","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211448"},{"key":"2025121511355333000_14.11.e089725.24","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1093\/rheumatology\/kead233","article-title":"Steady decrease in systemic sclerosis mortality rates at younger ages over the past five decades","volume":"63","author":"Yen","year":"2024","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.25","doi-asserted-by":"crossref","first-page":"3646","DOI":"10.1093\/rheumatology\/keaa827","article-title":"Health-related quality of life in patients with systemic sclerosis: evolution over time and main determinants","volume":"60","author":"van Leeuwen","year":"2021","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2025121511355333000_14.11.e089725.26","doi-asserted-by":"crossref","unstructured":"Alcala-Gonzalez LG , Guillen-del-Castillo A , Aguilar Cayuelas A , et al . n.d. Gastrointestinal dysmotility is associated with proton pump inhibitor refractory oesophagitis in patients with systemic sclerosis. Rheumatol Sunnyvale:keae481. doi:10.1093\/rheumatology\/keae481","DOI":"10.1093\/rheumatology\/keae481"},{"key":"2025121511355333000_14.11.e089725.27","doi-asserted-by":"crossref","unstructured":"Denton CP , De Lorenzis E , Roblin E , et al . The 2024 British Society for Rheumatology guideline for management of systemic sclerosis. Rheumatology (Sunnyvale) 2024;11. doi:10.1093\/rheumatology\/keae394","DOI":"10.1093\/rheumatology\/keae394"},{"key":"2025121511355333000_14.11.e089725.28","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209909"},{"key":"2025121511355333000_14.11.e089725.29","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/RHU.0000000000001144","article-title":"The Relationship Between Autonomic Dysfunction of the Gastrointestinal Tract and Emotional Distress in Patients With Systemic Sclerosis","volume":"27","author":"DiRenzo","year":"2021","journal-title":"J Clin Rheumatol"},{"key":"2025121511355333000_14.11.e089725.30","doi-asserted-by":"crossref","DOI":"10.1155\/2023\/6141790","article-title":"Clinically Recognized Depression and Mental Health Treatment in a Single Center Cohort of Patients with Systemic Sclerosis","volume":"2023","author":"Savoie","year":"2023","journal-title":"Int J Rheumatol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-089725","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:35:59Z","timestamp":1765827359000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-089725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,27]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-089725"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-089725","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}