DOI: 10.1111/apt.70931 ISSN: 0269-2813
Pruritus Is Frequent and Persistent and Impacts Quality of Life Among Patients With Primary Sclerosing Cholangitis
Richard Dean, Maryam Yazdanfar, Joseph Zepeda, Isha J. Patel, Cynthia Levy, Craig Lammert, Raghav Bordia, Duru Cosar, Katherine Specht, Daniel Pratt, Stuart C. Gordon, Lisa Forman, Fawzy Barry, Michael Li, Usha Gungabissoon, Megan M. McLaughlin, Christopher L. Bowlus ABSTRACT
Background
Pruritus is a common and burdensome symptom in patients with primary sclerosing cholangitis (
PSC
).
Aims
To determine the prevalence of pruritus in
PSC
, its clinical associations, and its impact on quality of life.
Methods
Patients with
PSC
were assessed for pruritus using the Worst Itch Numerical Rating Scale (
WI
‐
NRS
) and 5‐D Itch scale, and for quality of life using
SF
‐36 and
PSC
‐
PRO
. Participants reporting moderate to severe pruritus (
WI
‐
NRS
≥ 4) within 6 months of enrollment completed longitudinal assessments for up to 6 months. Those with inflammatory bowel disease (
IBD
) completed the Simple Clinical Colitis Activity Index (P‐
SCCAI
).
Results
Median age was 43 years, 61% were male and 75% had
IBD
. Moderate to severe itch over the prior 7 days was reported by 24%, increasing to 38% over the prior 6 months. Greater pruritus was associated with cirrhosis (
p
= 0.01), alkaline phosphatase (
p
= 0.0001), total bilirubin (
p
= 0.0006) and lower albumin (
p
= 0.01). Among patients with
IBD
, itch severity was associated with colitis activity (
p
= 0.01). Pruritus associated with impaired quality of life on the
SF
‐36 (
r
s
= −0.47) and
PSC
‐
PRO
(
r
s
= 0.69). Longitudinally, pruritus varied markedly with 86.5% of patients reporting moderate to severe pruritus in the past 6 months experiencing severe itch at least once over 6 months.
Conclusions
Pruritus is common, clinically meaningful and fluctuates over time in
PSC
. Its strong impact on quality‐of‐life underscores the need for standardized assessment and development of more effective therapies.