SSc Patients’ Health-related Quality of Life Worse Than Those With Other Rheumatoid Diseases, Study Finds

Patients with systemic sclerosis (SSc) have reduced health-related quality of life compared with other systemic rheumatoid diseases, a new study shows. A significant association between skin thickness scores and impaired quality of life also was reported in the study.

The study “Health-related quality of life in systemic sclerosis compared with other rheumatic diseases: a cross-sectional study,” was published in the journal Arthritis Research & Therapy.

According to previous studies, patients with SSc report reduced health-related quality of life compared with the general population. Compared with other chronic diseases, like cardiac, pulmonary disease, or diabetes, SSc patients also show similar or worse outcome scores in quality of life.

Still, only a few limited studies have compared health-related quality of life between SSc patients and those with other systemic rheumatic diseases.

To better understand the health status of SSc patients, a team led by researchers at Seoul National University College of Medicine, in South Korea, compared health-related quality of life among patients with SSc, rheumatoid arthritis, systemic lupus erythematosus, and Sjögren’s syndrome, and analyzed clinical factors linked to the quality-of-life-related changes (study NCT03257878).

This cross-sectional study (studying different groups with some shared characteristics) enrolled 480 patients, all 18 or older, randomly selected from outpatient rheumatology clinics of the Seoul National University Hospital; 120 patients were enrolled in each group, namely SSc, rheumatoid arthritis, systemic lupus erythematosus, and Sjögren’s syndrome. Six-hundred healthy controls were included for comparison.

Among SSc patients, 79 (65.8%) percent had diffuse cutaneous SSc (dcSSc), and the remaining had limited cutaneous SSc (lcSSc).

Researchers used three tools to assess health-related quality of life: the questionnaire Short Form Health Survey (SF-36); the Short Form Six-Dimensional health index (SF-6D); and the EuroQol Five-Dimensional descriptive system (EQ-5D-3L). These assessment tools scored physical functions (e.g., pain, mobility, or usual activities), as well as mental health parameters (e.g., anxiety, depression, or social skills).

Comparison between SSc patients and healthy controls showed that SSc patients had significantly lower self-reported health-related quality of life, assessed by physical and mental health functions using the three assessment tools.

Patients with SSc also showed significantly lower combined mental health and physical function scores, measured by SF-36, compared with rheumatoid arthritis or systemic lupus erythematosus patients.

Furthermore, compared with systemic lupus erythematosus patients, SSc patients experienced a higher degree of bodily pain.

In contrast, patients with Sjögren’s syndrome showed similar trends in health-related quality of life as SSc patients. The team noted, however, that the Sjögren’s syndrome patient population analyzed had lower disease activity compared with the other conditions analyzed (which were moderate-to-severe in disease activity). Because of that, the results should be interpreted with caution.

The team also analyzed potential factors associated with health-related quality of life, and found a significant association between the modified Rodnan skin score (mRSS; a score evaluating changes in skin thickness, a hallmark of SSc) and both physical and mental functions.

According to the results, the extent of affected skin in SSc patients was associated with a reduction in both physical and mental health-related quality of life (as measured by SF-36).

Longer disease duration and lower body mass index also were associated with reduced physical health-related quality of life.

Overall, the team concluded that “SSc patients reported greater impairments in mental health and poorer perception of general health than rheumatoid arthritis and systemic lupus erythematosus patients,” and that “the extent of skin involvement in SSc patients was associated with reduced physical and mental HRQoL [health-related quality of life] scores,” they wrote.

Researchers also emphasized that the results “indicate that we should pay more attention to the reported [health-related quality of life] and psychological status in patients with SSc,” and that “early diagnosis and assessment of organ involvements, as well as early, tailored, appropriate organ-based treatment would be advantageous to ensure better quality of life in SSc patients.”