• Vascular disease severity was associated with lower BMI and possible malnutrition in patients with systemic sclerosis.
• Intestinal pseudo-obstruction may also predict low BMI in SSc.

Vascular disease severity and intestinal pseudo-obstruction predicted lower BMI and possible malnutrition in patients with early systemic sclerosis, according to data published in Arthritis Care & Research.

“Malnutrition is common yet underrecognized in systemic sclerosis,” Zsuzsanna McMahan, MD, MHS, co-director of the UTHealth Houston Scleroderma Center, and associate professor of medicine in the division of rheumatology at the McGovern Medical School at the University of Texas Health Science Center, told Healio. “Although BMI is routinely used in clinical practice, there has been limited understanding of which early disease features predict nutritional risk over time.”

McMahan and colleagues aimed to fill this knowledge gap.

“This study was designed to move beyond cross-sectional assessments by leveraging longitudinal data from an early SSc cohort to identify baseline clinical markers that could enable earlier risk stratification and inform timely, targeted interventions,” McMahan said.

The analysis included 450 U.S. patients who met 2013 American College of Rheumatology/EULAR criteria for SSc. Patients with fewer than 5 years of disease duration from the first non-Raynaud’s symptoms were included. The mean follow-up duration was 5.3 years.

Univariate analysis results showed that participants with a younger age at baseline demonstrated a lower BMI ( = 0.06; P = .003).

According to the researchers, the key predictor of higher BMI in this analysis was anti-centromere antibody positivity ( = 1.69, P = 0.036). Predictors of lower BMI in the univariable analysis included pseudo-obstruction ( = –6.07; P = .026) and smaller oral aperture ( = 1.03; P < .001), along with higher Medsger vascular ( = –2.11; P < .001) and cardiac severity scores ( = –2.7; P = .049).

In a multivariate analysis that adjusted for sex, race and follow-up time, three factors associated with BMI remained significant. These included pseudo-obstruction ( = –6.28; P = .032), smaller oral aperture ( = 0.95; P = .049) and vascular severity ( = –0.85; P = .022), according to the researchers.

“Simple, clinically accessible features at baseline, particularly vascular disease severity, reduced oral aperture, and pseudo-obstruction, identify patients at risk for persistently lower BMI and potential malnutrition, even early in the disease course,” McMahan told Healio. “These findings reinforce the need for proactive nutritional surveillance in systemic sclerosis and highlight a possible link between vasculopathy and gastrointestinal dysfunction that may have implications for both monitoring and therapeutic strategies.”

Zsuzsanna McMahan, MD, MHS, can be reached at Zsuzsanna.H.McMahan@uth.tmc.edu.