Objectives To study the disability and health-related quality of life (HRQoL) in Chinese patients with SSc, and its relationship with the extent of skin involvement and organ damage.
Methods Consecutive patients who fulfilled the ACR preliminary classification criteria for SSc and an equal number of age and gender matched healthy controls were recruited for a cross-sectional study on HRQoL and disability. HRQoL was assessed by the validated Chinese version of the 36-item Medical Outcome Short Form (SF-36) questionnaire, whereas disability was assessed by the Chinese version of Health Assessment Questionnaire (HAQ). In patients with SSc, the extent of skin involvement was assessed by the modified Rodnan Skin score (mRSS) and organ damage of SSc was assessed by the systemic sclerosis severity index proposed by Medsger. The SF36 and HAQ score was compared between SSc patients and controls. Linear regression models were established to study the correlation among HAQ, SF36 score, Medsger severity index and clinical characteristics in patients with SSc.
Results 77 patients with SSc (87% women; mean age 50±12 years; disease duration 7.8±6.6 years) and 77 matched controls were studied. Fourteen (18%) patients had diffuse type of SSc (dcSSc) whereas the remaining had limited type of SSc (lcSSc). The median mRSS was 8 (IQR4-14; range0-37) points. The median severity index was 3 (IQR1-6; range0-18) points. The frequency of organ damage as assessed by the Medsger SSc severity index (≥1 point) was, in descending order: skin (96.1%), peripheral vascular damage (50.6%), joint/tendon contracture (33.8%), pulmonary system (33.8%), gastrointestinal tract (7.8%), renal system (7.8%), weight loss (5.2%), cardiovascular system (5.2%) and myopathy (2.6%). Compared to the healthy controls, the subscores of all the eight domains of the SF36, namely physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health, physical component sub-score, mental component subscore, and total SF36 score were significantly lower in SSc patients than controls (p<0.01 in all). The HAQ score was also significantly higher in patients with SSc compared to controls (p<0.01). In patients with SSc, linear regression analyses revealed that the HAQ score correlated positively and significantly with the mRSS score (Beta 0.483; p<0.01). The total SF36 score correlated inversely and significantly with the mRSS score (Beta-0.322;p=0.01), after adjustment for age, sex and duration of SSc. Regarding the individual organ systems of the Medsger severity index, the HAQ score correlated positively with skin damage (Beta0.412;p<0.01), peripheral vascular damage (Beta0.288;p=0.018), joint and tendon contracture (Beta0.377;p=0.001), myopathy (Beta0.294;p=0.011) and weight loss (beta0.314;p=0.005); whereas the total SF36 score correlated inversely and significantly with skin damage (Beta-0.353;p=0.003), joint and tendon contracture (Beta-0.291;p=0.015).
Conclusions Chinese patients with SSc have poorer HRQoL and greater disability than healthy controls. The quality of life of SSc patients is adversely affected by the extent of skin involvement and contracture of the joints and tendons. More skin and peripheral vascular damage, joint/tendon contracture and myopathy is associated with greater disability.
Disclosure of Interest None Declared
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