Association of pain and clinical factors on disability and quality of life in systemic sclerosis: A cross-sectional study from Turkish League Against Rheumatism Network
Remzi Çevik1
, Serda Em1, Kemal Nas2, Murat Toprak3, Gizem Cengiz4, Mustafa Çalış4, İlhan Sezer5, Ayşe Ünal Enginar5, Pınar Bora Karslı6, Sinem Sağ7, Betül Sargın8, Meltem Alkan Melikoğlu9, Yıldıray Aydın10, Mehmet Tuncay Duruöz11, Halise Hande Gezer11, Hilal Ecesoy12
1Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Dicle University School of Medicine, Diyarbakır, Türkiye
2Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
3Department of Physical Medicine and Rehabilitation, Yüzüncü Yıl University Faculty of Medicine, Van, Türkiye
4Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
5Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University, Faculty of Medicine, Antalya, Türkiye
6Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
7Rheumatology Clinic, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
8Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University, Faculty of Medicine, Aydın, Türkiye
9Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University Faculty of Medicine, Erzurum, Türkiye
10Department of Physical Medicine and Rehabilitation, Kapaklı State Hospital, Tekirdağ, Türkiye
11Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University Faculty of Medicine, Istanbul, Türkiye
12Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Türkiye
Keywords: Disability, pain, quality of life, systemic sclerosis.
Abstract
Objectives: In this study, we aimed to evaluate the factors associated with disability and quality of life (QoL) in Turkish patients with systemic sclerosis (SSc).
Patients and methods: Between January 2018 and January 2019, a total of 256 SSc patients (20 males, 236 females; mean age: 50.9±12.4 years; range, 19 to 87 years) who were diagnosed with SSc were included in the study. Disability and health-related QoL (HRQoL) were evaluated by the Health Assessment Questionnaire (HAQ), scleroderma HAQ (SHAQ), Duruöz Hand Index (DHI), and Short Form-36 (SF-36). Linear regression analysis methods were used to describe factors associated with disability and QoL of the patients.
Results: All disability scores were higher and HRQoL scores were lower in diffuse cutaneous SSc patients compared limited cutaneous SSc, and differentiations were significant (p=0.001 and p=0.007). In multiple regression, pain (VAS) was the strongest predictor for high disability and low QoL scores (p<0.001) as HAQ (β=0.397, 0.386, 0.452), SHAQ (β=0.397, 0.448, 0.372), DHI (β=0.446, 0.536, 0.389), PCS (β=-0.417,-0.499, -0.408) and MCS (β=-0.478, -0.441, -0.370) in combined, lcSSc and dcSSc patients respectively. The factors associated with high disability and low QoL scores were forced vital capacity for HAQ (β=-0.172, p=0.002) and SF-36 PCS (β=0.187, p=0.001); disease duration for HAQ (β=0.208, p<0.001), DHI (β=0.147, p=0.006), and SF-36 PCS (β=-0.134, p=0.014); 6-minute walk test for HAQ (β=-0.161, p=0.005) and SF-36 PCS (β=0.153, p=0.009); and modified Rodnan skin score for SHAQ (β=0.250, p<0.001) and DHI (β=0.233, p<0.001) in SSc patients. Diffusing capacity of the lungs for carbon monoxide for HAQ (β=-0.189, p=0.010) and SHAQ (β=-0.247, p=0.002); erythrocyte sedimentation rate for DHI (β=0.322, p<0.001); age for SF-36 PCS (β=-0.221, p=0.003) and body mass index for SF-36 PCS (β=-0.200, p=0.008) and MCS (β=-0.175, p=0.034) were the other variables associated with high disability or low QoL scores in SSc subsets.
Conclusion: Clinicians should consider the management of the pain and its sources as a key to improve better functional state and quality of daily life in SSc.
Citation: Çevik R, Em S, Nas K, Toprak M, Cengiz G, Çalış M, et al. Association of pain and clinical factors on disability and quality of life in systemic sclerosis: A cross-sectional study from Turkish League Against Rheumatism Network. Arch Rheumatol 2023;38(1):9-21.
The study protocol was approved by the Dicle University Hospital Ethics Committee (date, no: 21.12.2017/20). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Idea/concept: R.Ç., K.N.; Design, analysis and/or interpretation, literature review, writing the article, references: R.Ç.; Control/ supervision, critical review: R.Ç., S.E.; Data collection and/or processing: R.Ç., S.E., K.N., M.T., G.C., M.Ç., ‹.S., A.Ü.E., P.B.K., S.S., B.S., M.A.M., Y.A., M.T.D., H.H.G., H.E.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.