Medical signs and symptoms associated with disability, pain, and psychosocial adjustment in systemic sclerosis.

OBJECTIVE To examine physician-assessed medical signs and patient-reported medical symptoms as correlates of 3 quality of life (QOL) outcomes in patients with systemic sclerosis (SSc): disability, pain, and psychosocial adjustment. METHODS One hundred fourteen patients with SSc underwent a comprehensive clinical examination including determination of skin thickening [Modified Rodnan Skin Score (MRSS)]. Patients reported current symptoms and completed standardized questionnaires assessing disability and pain (Health Assessment Questionnaire) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale). Regression analysis was used to examine physician-determined and patient-reported correlates of the 3 outcomes. RESULTS MRSS was a significant correlate of all outcomes, although it explained only a small amount of the variance in psychosocial adjustment. Patient-reported postprandial bloating was the strongest correlate of psychosocial adjustment, explaining more than twice as much variance as MRSS. After accounting for MRSS, patient-reported dependent edema significantly correlated with all outcomes. For disability, significant correlates were physician-determined joint tenderness and number of tender points, and patient-reported joint pain on motion, joint contracture, extremity ulcers other than digital, and dyspnea. Patient-reported joint tenderness was significantly associated with pain. Regression analysis supported a model in which disability and pain mediated the relationship between MRSS and psychosocial adjustment. CONCLUSION Skin score is strongly associated with disability and pain, but only weakly associated with psychosocial adjustment. Dependent edema has negative implications across quality-of-life outcomes. Disability and pain mediate the relationship between disease severity and psychosocial adjustment to disease. Assessment (including self-report of patient symptoms) of specific medical signs and symptoms may indicate SSc patients experiencing diminished QOL.

[1]  Y. Allanore,et al.  Evaluation of depression and anxiety in patients with systemic sclerosis. , 2005, Joint, bone, spine : revue du rhumatisme.

[2]  R. Hays,et al.  Responsiveness of the SF-36 and the Health Assessment Questionnaire Disability Index in a systemic sclerosis clinical trial. , 2005, The Journal of rheumatology.

[3]  Sindhu R Johnson,et al.  The health assessment questionnaire disability index and scleroderma health assessment questionnaire in scleroderma trials: an evaluation of their measurement properties. , 2005, Arthritis and rheumatism.

[4]  B. Tilley,et al.  Correlates of depression, including overall and gastrointestinal functional status, among patients with systemic sclerosis. , 2005, The Journal of rheumatology.

[5]  R. Cattaneo,et al.  systemic sclerosis : correlations with indexes of disease activity and severity , disability , and depressive symptoms , 2005 .

[6]  M. Weisman,et al.  Relationships of Positive and Negative Affect to Coping and Functional Outcomes in Systemic Sclerosis , 2004, Cognitive Therapy and Research.

[7]  M. Weisman,et al.  Appearance Self-Esteem in Systemic Sclerosis , 1999, Cognitive Therapy and Research.

[8]  Y. Tada,et al.  Frequency and analysis of factors closely associated with the development of depressive symptoms in patients with scleroderma. , 2003, The Journal of rheumatology.

[9]  C. Denton,et al.  A cross-sectional comparison of three self-reported functional indices in scleroderma. , 2003, Rheumatology.

[10]  J. Haythornthwaite,et al.  Psychologic factors in scleroderma. , 2003, Rheumatic diseases clinics of North America.

[11]  Frederick Wolfe,et al.  The assessment of rheumatoid arthritis and the acceptability of self-report questionnaires in clinical practice. , 2003, Arthritis and rheumatism.

[12]  Richard W. Martin,et al.  Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenon. , 2002, Arthritis and rheumatism.

[13]  J. Haythornthwaite,et al.  The impact of pain and symptoms of depression in scleroderma , 2002, Pain.

[14]  K. Lorig,et al.  Effect of a self-management program on patients with chronic disease. , 2001, Effective clinical practice : ECP.

[15]  A. Drosos,et al.  Psychiatric Symptoms Associated with Scleroderma , 2001, Psychotherapy and Psychosomatics.

[16]  M. Mayes,et al.  The Disability Index of the Health Assessment Questionnaire is a predictor and correlate of outcome in the high-dose versus low-dose penicillamine in systemic sclerosis trial. , 2001, Arthritis and rheumatism.

[17]  Richard W. Martin,et al.  Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: high-dose versus low-dose penicillamine trial. , 2000, Arthritis and rheumatism.

[18]  E. M. Ahlmén,et al.  Development and evaluation of a patient education program for persons with systemic sclerosis (scleroderma). , 2000, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[19]  M. Mayes,et al.  Correlates of the disability index of the health assessment questionnaire: a measure of functional impairment in systemic sclerosis. , 1999, Arthritis and rheumatism.

[20]  F. Wolfe,et al.  Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. , 1999, Arthritis and rheumatism.

[21]  A. Stewart,et al.  Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. , 1999, Medical care.

[22]  K. Lorig,et al.  Arthritis self-management program variations: three studies. , 1998, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[23]  P. Merkel,et al.  Measurement of functional status, self-assessment, and psychological well-being in scleroderma. , 1998, Current opinion in rheumatology.

[24]  T. Medsger,et al.  The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. , 1997, Arthritis and rheumatism.

[25]  K. Darton,et al.  Psychological problems in patients with scleroderma: A controlled, prospective study , 1996 .

[26]  R. Roca,et al.  Depressive symptoms associated with scleroderma. , 1996, Arthritis and rheumatism.

[27]  V. Malcarne,et al.  Psychological adjustment to systemic sclerosis. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[28]  J. Poole,et al.  Concurrent validity of the Health Assessment Questionnaire Disability Index in Scleroderma. , 1995, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[29]  Richard W. Martin,et al.  Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. , 1995, The Journal of rheumatology.

[30]  A. Silman,et al.  Skin thickness score in systemic sclerosis: an assessment of interobserver variability in 3 independent studies. , 1993, The Journal of rheumatology.

[31]  D. Moser,et al.  Predictors of psychosocial adjustment in systemic sclerosis. The influence of formal education level, functional ability, hardiness, uncertainty, and social support. , 1993, Arthritis and rheumatism.

[32]  J. Poole,et al.  The use of the Health Assessment Questionnaire (HAQ) to determine physical disability in systemic sclerosis. , 1991, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[33]  L. Derogatis.  The psychosocial adjustment to illness scale (PAIS). , 1986, Journal of psychosomatic research.

[34]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[35]  J. Fries,et al.  The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. , 1982, The Journal of rheumatology.

[36]  A. Masi.  Preliminary criteria for the classification of systemic sclerosis (scleroderma). , 1980, Bulletin on the rheumatic diseases.