Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis

Luc Mouthon ^1*, Caroline Mestre-Stanislas ¹, Alice Bérezné ¹, François Rannou ¹, Philippe Guilpain ¹, Michel Revel ¹, Christian Pagnoux ¹, Loïc Guillevin ¹, Jacques Fermanian ² and Serge Poiraudeau ¹

¹ Paris Descartes University, COchin Hospital, France
² Department of Biostatistics Necker Hospital, France

^* To whom correspondence should be addressed. E-mail: luc.mouthon{at}cch.aphp.fr.

Accepted 6 February 2009

Abstract

Objective: To assess the impact of digital ulcers (DUs) on disability and health-related quality of life (HRQoL) in systemic sclerosis (SSc).

Methods: We evaluated 213 SSc patients at 4 annual meetings of a patient society between 2004 and 2007 (177) or during hospital stay (36). HRQoL was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS) and global hand and wrist mobility by the Kapandji index.

Results: Sixty-seven (31.4%) patients had at least one DU at the time of evaluation. Patients with DUs showed significantly more pitting scars (p<0.001) and calcinosis (p<0.0001) than others. Patients with DU had significantly greater HAQ (1.218±0.723 vs. 0.930±0.717, p=0.008), CHFS (27.38±20.68 vs. 16.73±18.19, p<0.0001) and aesthetic prejudice (6.1±2.2 vs 3.9±2.5, p<0.0001) scores than others. Hand and wrist mobility were significantly diminished in patients with DU (Kapandji score 75.3±22.8 vs 81.7±19.2, p<0.0001). The presence of a DU did not alter significantly the physical component, but influenced the mental component (43.38±12.53 vs 39.58±9.54, p=0.026) of the SF36.

Conclusion: SSc patients with DUs have reduced wrist and hand mobility, increased global and hand disabilities and decreased mental component of HRQoL.