Background Systemic sclerosis (SSc) is a diffuse connective tissue disease characterized by varying degrees of cutaneous and visceral fibrosis, presence of autoantibodies and vasculopathy. In addition to limitations and precautions in the everyday life of SSc patients, mood disorders are frequently observed.
Objectives To determine employment status in SSc and to determine the role of disease related features and mood disorders in its occurrence.
Methods Consecutive SSc patients from the State University of Campinas were enrolled. An interview was performed with all patients inquiring years of education, employment status (at disease-onset and currently) and reasons for unemployment. Mood disorders were determined through Becks Depression and Anxiety Inventory in all participants. SSc patients were further clinically and laboratory assessed to determine organ involvement, autoantibody profile (anti-topoisomerase I, anticentromere, and anti-RNA polymerase III), disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). Multivariate logistic regression was used to determine the likelihood of being unemployed, adjusting for sociodemographic characteristics, employment status at study entry, disease-related characteristics depression and anxiety.
Results One hundred and fifteen (101 females) SSc patients were included with a mean age of 50.85 years (SD=13.16). Anxiety was observed in 80 (69.69%) and depression in 43 (37.78%) SSc. At disease onset 85 (73.91%) were employed. During the disease course, work impairment was reported by 64 (66.7%) and main reasons were fatigue in 52 (81.3%), feeling sad in 40 (62.5%) and disease-related difficulties in 4 (6.3%). The number of employed SSc patients was reduced to 40 (40%) after a mean follow-up period of 10.9 (SD ±6.9) years. The main reason for unemployment stated was pain in 22 (49%), medical visits in 18 (40%) and low income in 4 (8.9%). Predictors for unemployment were depression [odds ratio (OR] 3.76, 95% confidence interval (95% CI) 1.88-7.52], anxiety (OR 1.7, 95% CI 1.1-4.3) and disease severity (OR 3.1, 95% CI 2.1-7.6).
Conclusions Unemployment is commonly observed during the disease course of SSc. Predictors for unemployment were mood disorders and disease severity. Mood disorders should routinely been screened in SSc patients due to its association with the risk of unemployment.
Disclosure of Interest None declared