THU0350 LOGOPEDIC TESTING IN SSC PATIENTS REVEALS HIGH FREQUENCY OF OROPHARYNGEAL DYSFUNCTION: A MONOCENTRIC EXPERIENCE
Authors: M. Wirths, O. Hudowenz, U. Hoffmann, U. Müller-Ladner, U. Lange, P. Klemm
Journal: Annals of the Rheumatic Diseases (2020)

Background: Up to 98% of patients with systemic sclerosis (SSc) show involvement of the gastrointestinal system (GI) [1]. While meteorism, heartburn and GI dysmotility are very common and accessible to pharmacologic treatment on an evidence based level [1–3], checking for oropharyngeal dysfunction is usually not part of the standard diagnostic algorithm. However, in a survey of the German Network for Systemic Sclerosis (DNSS) patients reported coughing and/or a sore voice in up to 78% [1]. As impairment in speaking or swallowing for example does not only substantially reduce quality of life, it can also be very stigmatizing. In addition, the usual prokinetic therapy of GI-involvement, e.g. metoclopramide, does not appear to improve these symptoms. As the first step to approach this problem is the qualitative and quantitative description, we evaluated the oropharyngeal function in our cohort of SSc patients by detailed logopedic assessment. Objectives: To evaluate the frequency and type of oropharyngeal dysfunction, e.g. swallowing or speaking, in patients with SSc and to elucidate the correlating and associated factors, e.g. disease duration or modified Rodnan Skin Score. Methods: After obtaining written consent, oropharyngeal function using a standardized assessment protocol was evaluated in patients with SSc fulfilling the ACR/EULAR criteria by a speech therapist. Furthermore, we investigated whether oropharyngeal dysfunction is associated with patients’ characteristics. In addition, all patients received instruction for a training program to treat their individual oropharyngeal dysfunction. Results: 37 patients with d/lSSc were assessed for eligibility. 34 patients met the inclusion criteria (3 patients did not speak German) and written consent was obtained. Oropharyngeal dysfunction (impairment of speaking, swallowing, breathing or oropharyngeal muscle function) was found in 29 of 34 (85%) of both l/dSSc patients. Neither the subtype of SSc, disease duration nor mRSS were significantly correlated with oropharyngeal dysfunction in general. Only GI involvement in general was associated with oropharyngeal dysfunction. After logopedic therapy, 28 of the 34 (82%) patients with oropharyngeal dysfunction reported a benefit after 3 days of training and were motivated to continue logopedic training at home. Oropharyngeal dysfunction Present (n=29) absent (n=5) p-values (x 2 -test) dcSSc 8 0 0,027 lcSSc 22 4 0,027 disease duration (mean) 12,7 y 12 y 0,462 mRSS&lt;4 9 2 0,322 mRSS&gt;4 20 3 0,322 Raynauds syndrom 29 5 0,673 digital ulcers 19 2 0,812 lung fibrosis 11 2 0,596 eosophageal dilatation 15 2 0,566 eosophageal dysmotility 19 0 0,015 GI-involvement 23 1 0,007 Conclusion: Logopedic assessment revealed a high incidence of oropharyngeal dysfunction in our cohort of SSc patients. Oropharyngeal dysfunction was not associated with disease duration, skin- or lung-involvement or dcSSc/lcSSc differentiation. A logopedic training program seems to be of benefit for this currently not pharmacologically treatable problem. References: [1]Schmeiser T, Saar P, Jin D, Noethe M, Müller A, Soydan N, et al. Profile of gastrointestinal involvement in patients with systemic sclerosis. Rheumatol Int 2012;32:2471–8. doi: 10.1007/s00296-011-1988-6. [2]Boeckxstaens GE, Bartelsman JFWM, Lauwers L, Tytgat GNJ. Treatment of GI dysmotility in scleroderma with the new enterokinetic agent prucalopride. Am J Gastroenterol 2002;97:194–7. doi: 10.1016/S0002-9270(01)03958-2. [3]Mercado U, Arroyo de Anda R, Avendaño L, Araiza-Casillas R, Avendaño-Reyes M. Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities. Clin Exp Rheumatol 2005;23:685–8. Disclosure of Interests: Miriam Wirths: None declared, Ole Hudowenz: None declared, Ulrike Hoffmann: None declared, Ulf Müller-Ladner Speakers bureau: Biogen, Uwe Lange: None declared, Philipp Klemm Consultant of: Lilly, Medac