Background Systemic sclerosis (SSc) is a chronic autoimmune disease associated with an impaired quality of life, as assessed by SF-36. There are no studies investigating quality of life in early SSc patients (eSSc), as defined by Koenig et al (1).
Objectives To assess HRQOL of eSSc patients compared to that of definite SSc patients (defSSc) fulfilling ACR criteria (2).
Methods 81 patients consecutively admitted to the Rheumatology Unit of the Second University of Naples from January 1st, 2007 to December 31st 2010 were enrolled in the study. Demographics, disease duration, disease activity and severity and SF-36 were assessed at admission. Patients were classified into 2 groups: eSSc patients according to Koenig et al. (i.e. patients with Raynaud’s phenomenon plus either SSc auto-antibody or an SSc pattern on nailfold capillaroscopy or both) and defSSc patients fulfilling the ACR criteria.
Results Out of the 81 patients, 31 were classified as eSSc and 50 as defSSc patients. ESSc patients showed a Physical Component summary score (PCS) ranging from 22 to 56 (median 45) and a Mental Component summary score (MCS) ranging from 25 to 67 (median 43); defSSc patients showed a PCS ranging from 23 to 59 (median 39) and a MCS from 20 to 62 (median 41). Fifty is defined the lower normal limit of both PCS and MCS in general population (3). A PCS score lower than 50 was recorded in 17 out of 31 eSSc patients and in 32 out of 50 defSSc patients (p=0.711); a MCS score lower than 50 was recorded in 22 out of 31 eSSc patients and 34 out of 50 defSSc patients (p=0.988). Among the domains that contribute to PCS, a score lower than normal was found for general health (48%), bodily pain (32%), physical role (29%) domains in eSSc patients and for physical function (54%), general health (50%) and physical role (26%) domains for defSSc patients. Concerning mental component, limitations in daily activities due to emotional role were the most frequent finding in both groups.
Conclusions HRQOL is reduced in a significant percentage of both eSSc and defSSc patients. Despite the absence of any clinical manifestation other than Raynaud’s phenomenon, eSSc patients, therefore, display an impairment in quality of life, that should be considered by the clinician attending such patients.
Koenig M et al. Autoantibodiesand microvascular damage are independent predictive factors for the progression of Raynaud’s phenomenon to systemic sclerosis: a twenty-year prospective study of 586 patients, with validation of proposed criteria for early systemic sclerosis. Arthritis Rheum. 2008;58:3902-12.
Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980;23:581-90.
Ware JE Jr et al. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-83.
Disclosure of Interest None Declared