Background The Mouth Handicap in Systemic Sclerosis Scale (MHISS) is a 12-item questionnaire proposed and validated by Mouthon L et al (Ann Rheum Dis 2007; 66: 1654-1655) which assesses mouth disability in Systemic Sclerosis (SSs). Items are organized in 3 subscales measuring oral aperture, xerostomia and stetic damage.
Objectives To evaluate the applicability of MHISS in Spanish SSc patients, as well as its correlation with various clinic variables and specific measures of the disease.
Methods Multicentric, descriptive and cross-sectional study with analytic components. SSc patients from two hospitals were assessed regarding mouth disability by means of the MHISS. This questionnaire had previously been translated and adaptated into Spanish. Clinical assessment was simultaneously performed, and the next variables were collected: age, time since SSc diagnosis, modified Rodnan skin score(mRSS), oral aperture measurement, oesophageal symptoms, sicca syndrome(SS), and smoking habit. All patients were evaluated, in each of the hospitals, by the same expert rheumatologist. SPSS Statistics 17.0 was used for data analysis, and percentages, means(SD) and medians(range) were assessed for describing variables. Pearson’s test was used to assess the correlation between MHISS and quantitative variables, and Spearman’s coefficient for the correlation between MHISS and qualitative variables, interpreted as excellent(>0.8), good(0.6-0.8), moderate(0.4-0.6), and poor(<0.4).
Results A total of 56 patients were evaluated(51 female, 5 male; 40 lSSc, 16 dSSc; age and disease duration: 52±15, 11±9 years; 30% smokers; 45% with oesophageal symptoms; 54% with SS). Mean total MHISS was 16±12, being higher in dcSSc patients (20±15) than in lcSSc(15±10). Oesophageal symptoms, mRSS and mouth opening limitation were also higher in dSSc than in lSSc patients. No differences were found regarding the existence of SS. When analyzing all of the patients, we detected an acceptable negative correlation between mRSS and oral aperture(r: -0.57), as well as between oral aperture and MHISS(r: -0.57). There was a good correlation between the presence of SS and questionnaire items 7 and 8, related to xerostomia (r: 0.69). This correlation was even better when considering dSSc patients separately(r: 0.83). In dSSc patients, correlations between mRSS and oral aperture, and between oral aperture and MHISS were also better(r:-0.6 and -0.66, respectively). Moreover, disease duration showed a good correlation with oral aperture(r: -0.75) and MHISS(r: 0.66). On the other hand, correlations between mRSS and oral aperture(r: -0.5), as well as between oral aperture and MHISS(r: -0.47) were found to be moderate in lSSc patients. Even though there were no differences regarding the existence of SS, correlation between this variable and MHISS items related to xerostomia was lower(r: 0.64) in lSSc patients.
Conclusions The Spanish adaptation of MHISS is useful in spanish SSc patients, mainly measuring mouth disability related to the degree of skin involvement and xerostomia, and specially in dSSc patients.
Disclosure of Interest None Declared
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