By Eleanor McDermid, medwireNews Reporter
medwireNews: Post-hoc analysis of a randomised trial shows that the severity of reflux symptoms in patients with systemic sclerosis (SSc) predicts radiographic progression of interstitial lung disease (ILD).
As reported in Arthritis Care & Research, Elizabeth Volkmann (University of California, Los Angeles, USA) and co-researchers explored the association using data from the Scleroderma Lung Study II randomised trial.
They explain that while a cross-sectional relationship is well established, the dataset from this trial “provided a unique opportunity to examine how the severity of esophageal reflux at baseline is related to radiographic ILD progression over time”.
The baseline average reflux scale score, available for 141 of the 142 trial participants, was 0.57, indicating moderate reflux. Baseline quantitative interstitial lung disease (QILD) as a percentage of the whole lung was about 30% and quantitative lung fibrosis (QLF) about 8.5%.
During the 24 months of trial follow-up, the baseline reflux score was positively associated with changes in QLF, both for the whole lung and the lobe of maximal involvement, such that patients with more severe reflux either had less improvement or progressed relative to those with less reflux.
This association persisted after accounting for variables including trial medication, baseline QLF score and proton-pump inhibitor use. Baseline reflux score was also independently associated with changes in QILD, albeit only for the whole lung.
Of note, the researchers found that oesophageal diameter and area were not significantly associated with either baseline reflux severity or ILD progression, despite these having been proposed as independent and objective measures of oesophageal involvement in SSc.
Reflux severity was not, on the whole, associated with baseline measures of ILD; however, Volkmann and team highlight a “weak correlation” between reflux severity and ground glass opacity in the lobe of maximum involvement.
They say this could indicate that aspiration resulting from oesophageal reflux could “perpetuate pulmonary inflammation and fibrosis in SSc”, but caution that further prospective research is needed to determine this.
More research is also required “to determine whether other treatments aimed at reducing aspiration events due to [gastro-oesophageal reflux disease] (e.g., promotility agents), could improve outcomes for patients with SSc-ILD”, say the study authors.
They conclude: “Optimizing the treatment of esophageal involvement in SSc not only may provide symptomatic relief for patients, but it may also represent a life-extending measure for patients with this often-fatal disease.”
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Arthritis Care Res 2022; doi:10.1002/acr.25070