Three-Year Study Reveales Functional Disability and Fatigue Scores Remain Stable in Systemic Sclerosis Patients

Patrícia Silva, PhD avatar

by Patrícia Silva, PhD |

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According to a news release, it was recently reported at the European League Against Rheumatism (EULAR) Annual European Congress of Rheumatology in June 2015 that the functional disability and fatigue associated with systemic sclerosis remains stable in patients for a period of at least three years.

Systemic sclerosis is a rare, chronic autoimmune disease in which the body’s own immune system attacks healthy tissues resulting in a hardening and tightening of the connective tissues due to excessive collagen deposition. The disease usually affects the skin, but it can also affect internal organs such as the lungs, heart, blood vessels, kidneys and the digestive tract. Fatigue is a common complaint in systemic sclerosis patients. The disorder can be classified into limited or diffuse based on the extent of skin tightening. In the limited disease, skin tightening is confined to the fingers, hands and forearms; it can also occur on the feet and legs. In the diffuse disease, the skin of the proximal extremities and trunk is also involved.

The goal of the study was to assess the link between systemic sclerosis, fatigue and functional disability. Researchers analyzed 215 systemic sclerosis patients, with a mean age of 56.4 years, and mean disease duration of 9.2 years. 75.1% of the patients had limited disease. The team used the Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the patient’s functional status, and the SF-36 vitality subscale to evaluate fatigue at baseline and after a follow-up period of three years.

Researchers found that in terms of functional disability, patients could be divided into two groups, a “stable-low” group with low baseline HAQ-DI scores (133 patients) and a “stable-high” group with high baseline disability scores (82 patients). The team reported a slight but not significant decline in functional disability after three years.

Regarding fatigue, the patient cohort could also be divided into two groups, a “stable-moderate” group (99 patients) and a “stable-severe” group (116 patients). Researchers found a statistically non-significant small decline in fatigue scores in both groups after the three years of the study.

The team reported that systemic sclerosis patients in the stable-high group in terms of disability were more likely to be women and to experience fatigue. Patients in the stable-severe fatigue group were found to be more likely women, to experience lung involvement as part of the disease, and to exhibit less disease acceptance. Interestingly, a significant association was found between disability and fatigue subgroups.

The research team concluded that in the systemic sclerosis patient cohort analyzed, functional disability and fatigue were two parameters that remained stable during disease course as evaluated in a three-year period. These findings are especially relevant given the fact that it is often believed among patients that systemic sclerosis causes increasing disability and symptom aggravation over time. This study contributes to the growing idea that systemic sclerosis is in fact not necessarily a progressive disease.