Pruritus Is Frequent and Persistent and Impacts Quality of Life Among Patients With Primary Sclerosing Cholangitis.

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 (rs = -0.47) and PSC-PRO (rs = 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.