Digital ulcers, Raynaud's, GI issues biggest detriments to QoL in systemic sclerosis
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Digital ulcers, Raynaud symptoms and gastrointestinal complications are the biggest contributors to worsening quality of life in patients with systemic sclerosis, according to data published in Rheumatology.
“Previous studies have evaluated SSc-related HRQoL cross-sectionally,” Nina M. van Leeuwen, MD, who at the time of the study was a researcher at Leiden University Medical Center, in the Netherlands, and colleagues wrote. “Pain, dyspnea, digital ulcers (DU), [Raynaud’s phenomenon (RP)] and gastrointestinal (GI) manifestations have been shown to have a negative influence on HRQoL. Most of the available evidence originates from studies with cross-sectional designs and focuses on one clinical characteristic. Other studies evaluated data from randomized controlled trials with a relatively short reassessment period.”
“Due to the chronic nature of SSc, it is of additional importance to assess which disease manifestations have largest impact on disease-related HRQoL longitudinally,” they added. “This is of additional importance for design of therapeutic trials where manifestations with the highest clinical burden should be taken into account.”
To analyze whether and how health-related quality of life changes over time among patients with SSc, as well as assess how various disease domains and related impairments impact these changes, van Leeuwen and colleagues studied all patients followed in the Leiden University Medical Center’s ongoing, prospective, observational SSc cohort. The researchers focused on the period from 2009 to 2019, and classified patients with a disease duration of less than 24 months as incident cases. In all, 492 patients with SSc, including 202 incident cases, were analyzed in the study. The median follow-up was 3.4 years.
Leeuwen and colleagues prospectively examined health-related quality of life annually, using the Short Form-36 (SF36) and the EuroQol Five-Dimensional descriptive system (EQ-5D). They performed linear regressions to assess baseline associations between clinical characteristics and health-related quality of life, and used linear mixed models in bot incident and prevalent cases to find associations between SSc characteristics and changes in quality of life over time.
According to the researchers, baseline organ involvement was independently associated with a worse SF36 physical component score and a lower EQ-5D score. In addition, gastrointestinal symptoms, Raynaud’s disease and digital ulcers were, over time, independently associated with worsening health-related quality of life in both incident and prevalent cases. Among prevalent cases, pulmonary arterial hypertension was associated with a decrease in health-related quality of life over time.
Additionally, worse functioning — based on 6-minute walking distance, mouth-opening, finger-to-palm distance and grip strength — was a significant contributor to lower health-related quality of life over time.
“This study provides unique information about the most important determinants of HRQoL in SSc,” van Leeuwen and colleagues wrote. “Deeper knowledge of factors significantly influencing not only HRQoL, but also changes of HRQoL over time, is of relevance to tailor most appropriate treatment strategies. Moreover, a thorough understanding of HRQoL determinants may help caring physicians to identify the unmet needs of SSc patients and the areas where more vigorous pharmacological or non-pharmacological interventions are indicated.”
“We confirm previous findings about the impact of RP, hand function, skin involvement and GI symptoms on daily life of SSc patients, but we also outline the possibility that these factors may predict further HRQoL deterioration,” they added. “Our results suggest that major attention should be paid to GI symptoms, Raynaud and DU as possible predictors of worsening HRQoL. In addition, in patients with longstanding disease, PAH is importantly influencing HRQoL over time.”
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