Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group
Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group
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DOI：
10.1093/rheumatology/kex182
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发表时间：
2018-03-01
期刊：
影响因子：
5.5
通讯作者：
Walker, Ulrich A.
中科院分区：
文献类型：
--
作者：
Jaeger, Veronika K.;Distler, Oliver;Walker, Ulrich A.
SSc的多系统表现可极大地影响患者的生活质量。本研究的目的是确定与SSc残疾相关的因素。来自前瞻性DeSSipher队列的SSc患者完成了硬皮病健康评估问卷（SHAQ），这是一种结合健康评估问卷和五种视觉模拟量表的残疾评分，被纳入本分析。944例患者的SHAQ和HAQ评分平均为0.87（s.d.），平均为0.88（s.d.）。= 0.66）和0.92（s.d. = 0.78）; 59%的患者属于轻度至中度困难SHAQ类别（0 a（c）1/2 SHAQ < 1），34%属于中度至重度残疾类别（1 a（c）1/2 SHAQ < 2），7%属于重度至极重度残疾类别（2 a（c）1/2 SHAQ a（c）1/2 3）。视觉模拟量表评分的平均值按大小顺序为：总体疾病严重程度（37 mm）、RP（31 mm）、肺部症状（24 mm）、胃肠道症状（20 mm）和指端溃疡（19 mm）。在多元回归分析中，与SHAQ评分高相关的主要因素是呼吸困难[改良纽约心脏协会（NYHA）IV级（回归系数B = 0.62），改良NYHA III级（B = 0.53）和改良NYHA II级（B = 0.21;所有改良NYHA I级）]，FM（B = 0.37），肌无力（B = 0.27），指端溃疡（B = 0.20）和胃肠道症状（食管症状，B = 0.16，胃症状，B = 0.15;肠症状，B = 0.15）。SSc患者认为呼吸困难、疼痛、指溃疡、肌无力和胃肠道症状是驱动其残疾程度的主要因素，这与强调残疾的客观测量的医生不同。
The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc.SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions.The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 a (c) 1/2 SHAQ < 1), 34% in the moderate to severe disability category (1 a (c) 1/2 SHAQ < 2) and 7% in the severe to very severe disability category (2 a (c) 1/2 SHAQ a (c) 1/2 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15).SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability.