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Avanoglu-Guler A, Campochiaro C, De Luca G, Hughes M, Tufan A, Green L, Del Galdo F, Matucci-Cerinic M, Dagna L. Calcinosis in systemic sclerosis: An update on pathogenesis, related complications, and management: A heavy burden still waiting to be lifted off patients' hands. Semin Arthritis Rheum 2024; 66:152431. [PMID: 38537324 DOI: 10.1016/j.semarthrit.2024.152431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/18/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
In SSc, dystrophic calcinosis is one of the major clinical manifestations, characterized by the deposition of insoluble calcific substances in tissues, predominantly in the chemical form of calcium hydroxyapatite. Furthermore, calcinosis might lead to compressive neuropathies and severe pain. Current evidence suggests that tissue ischemia and repeated trauma are implicated in the development of calcinosis; however, there are still too many unknown areas that need to be investigated. Detection of calcinosis is commonly performed using X-ray or ultrasound. Moreover, quantification of calcinosis with X-ray and dual-energy computed tomography might be useful for the assessment of disease burden and monitoring of the disease. Despite its prevalence and clinical outcomes, there are no approved disease-modifying treatments for calcinosis in SSc. Debulking or surgical intervention might be preferred for calcinosis complicated with infection, compressive symptoms, or relief of pain. Therefore, innovative investigations and tailored therapeutic approaches are urgently needed to lift the burden of calcinosis from the hands of SSc patients.
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Affiliation(s)
- Aslihan Avanoglu-Guler
- Department of Internal Medicine, Division of Rheumatology, Gazi University, Ankara, Turkey; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy.
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Michael Hughes
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Group, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, UK
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University, Ankara, Turkey; Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds and Leeds Teaching Hospitals Trust, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds and Leeds Teaching Hospitals Trust, Leeds, UK
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
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2
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Sahin EI, Cetin SY, Ayan A. Investigation of the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis: a randomized controlled trial. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230252. [PMID: 37729360 PMCID: PMC10508901 DOI: 10.1590/1806-9282.20230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis and to compare with patient education. METHODS A total of 46 individuals with systemic sclerosis (55.52±11.54 years) were included. Individuals were randomly assigned into intervention (n=23) and control (n=23) groups. Dynamometer, goniometer, Canadian Occupational Performance Measurement, Disabilities of the Arm, Shoulder, and Hand, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index were used for evaluation. RESULTS Post-treatment, in terms of delta (Δ) values, hand grip and pinch strengths (p: 0.000-0.016), active (p: 0.000-0.032) and passive (p: 0.000-0.043) total range of motions, Canadian Occupational Performance Measurement performance and satisfaction, Disabilities of the Arm, Shoulder, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index (p: 0.000) were in favor of the intervention group. CONCLUSION Upper extremity home exercises increase grip strength, range of motion, activity performance, and functionality in patients with systemic sclerosis. We recommend that rehabilitation programs include not only hand exercises but also upper extremity exercises.
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Affiliation(s)
- Emine Irem Sahin
- Akdeniz University, Institue of Health Sciences, Department of Physiotherapy and Rehabilitation – Antalya, Turkey
| | - Sebahat Yaprak Cetin
- Akdeniz University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation – Antalya, Turkey
| | - Ayse Ayan
- Health Sciences University, Department of Rheumatology – Antalya, Turkey
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3
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Chen YT, Lescoat A, Khanna D, Murphy SL. Perceived Cognitive Function in People With Systemic Sclerosis: Associations With Symptoms and Daily Life Functioning. Arthritis Care Res (Hoboken) 2023; 75:1706-1714. [PMID: 35997486 PMCID: PMC9947182 DOI: 10.1002/acr.25000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perceived cognitive dysfunction is prevalent in patients with systemic sclerosis (SSc) but not well understood. This study aimed to examine potential factors associated with perceived cognitive function and to investigate the contributions of perceived cognitive function and symptoms to functional measures. METHODS A cross-sectional survey was conducted among patients with SSc (n = 106). Participants were mainly female (84%) and White (82%). Perceived cognitive function, symptoms, and functional measures were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) measures. A multivariable regression was conducted to identify factors associated with perceived cognition. Hierarchical linear regressions examined the unique contributions of perceived cognitive function and symptoms to social participation and physical function. RESULTS Fifty-nine (56%) patients with SSc perceived mild-to-severe cognitive dysfunction. Being on work disability and having more fatigue were both significantly associated with perceived cognitive dysfunction. When examining the contributions of cognition and other symptoms to functional measures, self-reported cognition became nonsignificant after fatigue and pain were entered into the regression model. CONCLUSION Being on work disability and having more fatigue were most highly associated with perceived cognitive dysfunction in patients with SSc. Unlike fatigue and pain, perceived cognitive function was not independently associated with functional measures. Nonetheless, future research should disentangle cognitive function and other symptoms, as well as their effects on daily activities, in SSc.
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Affiliation(s)
- Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Cordeiro RA, Fischer FM, Shinjo SK. Work situation, work ability and expectation of returning to work in patients with systemic autoimmune myopathies. Rheumatology (Oxford) 2023; 62:785-793. [PMID: 35866618 DOI: 10.1093/rheumatology/keac389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To document the work situation, the work ability and the expectation of returning to work among adult patients with systemic autoimmune myopathies (SAMs), and to identify the factors associated with each of these outcomes. METHODS Cross-sectional study. The work situation (performing paid work vs out of work) was ascertained via a structured questionnaire. For those who were working, we applied the Work Ability Index (WAI; scale 7-49); and for those who were out of work, we applied the Return-to-Work Self-Efficacy questionnaire (RTW-SE; scale 11-66). RESULTS Of the 75 patients with SAMs included, 33 (44%) were doing paid work and 42 (56%) were out of work. The work situation was independently associated with physical function, assessed by the Health Assessment Questionnaire-Disability Index (HAQ-DI). A 1-point increase in the HAQ-DI (scale 0-3) decreased the chance of doing paid work by 66% (95% CI: 0.16, 0.74; P = 0.007). Patients performing paid work had a mean WAI of 33.5 (6.9). The following variables were associated with a decrease in the WAI score in the regression model: female sex (-5.04), diabetes (-5.94), fibromyalgia (-6.40), fatigue (-4.51) and severe anxiety (-4.59). Among those out of work, the mean RTW-SE was 42.8 (12.4). Cutaneous manifestations and >12 years of education were associated with an average increase of 10.57 and 10.9 points, respectively, in the RTW-SE. A 1-point increase in the HAQ-DI decreased the RTW-SE by 4.69 points. CONCLUSION Our findings highlight the poor work participation in a well-characterized sample of working-age patients with SAMs. Strategies to improve work-related outcomes in these patients are urgently needed.
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Affiliation(s)
| | - Frida M Fischer
- Department of Environmental Health, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Kiss F, Farkas N, Nagy G, Minier T, Kumánovics G, Faludi R, Czirják L, Varjú C. Minimal Clinically Important Differences (MCID) for the Functional Assessment of Chronic Illness Therapy Fatigue Scale in Patients with Systemic Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:771. [PMID: 36613093 PMCID: PMC9819291 DOI: 10.3390/ijerph20010771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Systemic sclerosis (SSc) is characterized by significant fatigue, causing diminished quality of life (QoL). The aim of this study was to examine fatigue levels and their associations with clinical factors and determine the minimal clinically important difference (MCID) value for the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-FS). (2) Methods: A total of 160 SSc patients and 62 individuals without SSc were followed-up over a 12-month period by measuring the FACIT-FS and the Visual Analogue Scale and the Short Form 36 Vitality Score analyzing changes in exhaustion. (3) Results: Fatigue was strongly correlated with HRQoL, level of pain, emotional disorders, physical capability and functionality. The MCID values for FACIT-FS were calculated as -3 for deterioration and +4 for improvement after a 12-month follow-up. The predictors of improvement of fatigue from baseline parameters were the significant disease activity, the patients' poorer functionality and the short disease duration. Patients with scleroderma-related interstitial lung disease at baseline had approximately tripled risks for worsening fatigue. The independent influential factors regarding the changing of FACIT-FS were improving or worsening in the same direction in reference to physical condition, gastrointestinal and emotional factors. (4) Conclusions: Fatigue is a multi-dimensional symptom, which is strongly correlated to HRQoL. MCID values of FACIT-FS can be useful tools in monitoring the changes of HRQoL in clinical trials and in daily practice among patients with SSc.
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Affiliation(s)
- Franciska Kiss
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Gabriella Nagy
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Tünde Minier
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
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Boelhouwer IG, Vermeer W, van Vuuren T. Work ability among employees 2–10 years beyond breast cancer diagnosis: Late treatment effects and job resources - A longitudinal study. Work 2022; 74:1061-1076. [PMID: 35527613 DOI: 10.3233/wor-211288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The number of workers who have previously undergone a cancer treatment is increasing, and possible late treatment effects (fatigue, physical and cognitive complaints) may affect work ability. OBJECTIVE: The aim of the study was to investigate the impact of late treatment effects and of job resources (autonomy, supportive leadership style, and colleagues’ social support) on the future work ability of employees living 2–10 years beyond a breast cancer diagnosis. METHODS: Data at T1 (baseline questionnaire) and at T2 (9 months later) were collected in 2018 and 2019 (N = 287) among Dutch-speaking workers with a breast cancer diagnosis 2–10 years ago. Longitudinal regression analyses, controlling for years since diagnosis, living with cancer (recurrence or metastasis), other chronic or severe diseases, and work ability at baseline were executed. RESULTS: Higher levels of fatigue and cognitive complaints at baseline predicted lower future work ability. The three job resources did not predict higher future work ability, but did relate cross-sectionally with higher work ability at baseline. Autonomy negatively moderated the association between physical complaints and future work ability. CONCLUSIONS: Fatigue and cognitive complaints among employees 2–10 years past breast cancer diagnosis need awareness and interventions to prevent lower future work ability. Among participants with average or high levels of physical complaints, there was no difference in future work ability between medium and high autonomy. However, future work ability was remarkably lower when autonomy was low.
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Affiliation(s)
- Ingrid G. Boelhouwer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Willemijn Vermeer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Tinka van Vuuren
- Department Organisation, Faculty of Management, Open Universiteit, Heerlen, The Netherlands
- Loyalis Knowledge & Consult, Heerlen, The Netherlands
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Galetti I, Nunzio SD, Brogelli L, Mirisola V, Garbagnati C. How do systemic sclerosis manifestations influence patients' lives? Results from a survey on patients and caregivers. Curr Med Res Opin 2021; 37:5-15. [PMID: 34726112 DOI: 10.1080/03007995.2021.1992371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the patient- and caregiver-reported impact of systemic sclerosis (SSc) manifestations (hand/feet/joint involvement and pulmonary complications) on the diagnostic and therapeutic journey, working productivity, and social life. METHODS Two questionnaires (one for the patients, n = 260 and one for the caregivers, n = 47) were designed in collaboration with the patients' association Gruppo Italiano per la Lotta alla Sclerodermia (GILS). Validated questionnaires were combined with specific questions relevant to the Italian scenario. RESULTS Pulmonary fibrosis and hand/feet/joint involvement have a major impact on patient's working status: (85.3% of patients with pulmonary fibrosis and 72.6% with hand/feet/joint involvement report loss of job/job change due to SSc. Productivity was affected as well: 60.6% of the patients (75% of those with fibrosis) reported that working productivity in the previous 4 weeks was restricted by physical limitations. The disease has a significant impact on patients' life, limiting the ability to conduct common activities, especially those related to movement, such as object manipulation (61.1%), doing small manual jobs (44.0%), writing (38.9%), and an increased impact in case of pulmonary fibrosis and hands/feet/joints involvement. Half of the patients also present some difficulties in eating-related activities a Patients also experience poorer social life, personal relationships, and sexual life. Caregivers are also deeply influenced by the manifestations of SSc. Pulmonary fibrosis and hand/feet/joint involvement represent an additional challenge. CONCLUSION Pulmonary fibrosis and hand/feet/joint involvement are extremely burdensome complications for both SSc patients and caregivers, decreasing work productivity, limiting relationship and social life, and impacting psychological status and everyday activities.
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Affiliation(s)
- Ilaria Galetti
- GILS, Gruppo Italiano per la Lotta alla Sclerodermia, Milan, Italy
| | | | | | | | - Carla Garbagnati
- GILS, Gruppo Italiano per la Lotta alla Sclerodermia, Milan, Italy
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Santiago T, Santos E, Duarte AC, Martins P, Sousa M, Guimarães F, Azevedo S, Ferreira RM, Guerra M, Cordeiro A, Cordeiro I, Pimenta S, Pinto P, Pinto AM, Salvador MJ, Silva JAPD. Happiness, quality of life and their determinants among people with systemic sclerosis: a structural equation modelling approach. Rheumatology (Oxford) 2021; 60:4717-4727. [PMID: 33521812 DOI: 10.1093/rheumatology/keab083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' objectives and experiences must be core to the study and management of chronic diseases, such as SSc. Although patient-reported outcomes are attracting increasing attention, evaluation of the impact of disease on the overall subjective well-being, equivalent to 'happiness', is remarkably lacking. OBJECTIVES To examine the determinants of happiness and quality of life in patients with SSc, with emphasis on disease features and personality traits. METHODS Observational, cross-sectional multicentre study, including 142 patients, with complete data regarding disease activity, disease impact, personality, health-related quality of life (HR-QoL) and happiness. Structural equation modelling was used to evaluate the association between the variables. RESULTS The results indicated an acceptable fit of the model to the data. Perceived disease impact had a significant negative direct relation with HR-QoL (β = -0.79, P < 0.001) and with happiness (β = -0.52, P < 0.001). Positive personality traits had a positive relation with happiness (β = 0.36, P = 0.002) and an important indirect association upon QoL (β = 0.43) and happiness (β = 0.23). Perceived disease impact is influenced by body image, fatigue and SSc-related disability to a higher degree (β = 0.6-0.7) than by disease activity (β = 0.28) or form (β = 0.17). Impact of disease had a much stronger relation with HR-QoL than with happiness. CONCLUSIONS The results suggest that treatment strategies targeting not only disease control but also the mitigation of relevant domains of disease impact (body image, fatigue, global disability) may be important to improve patients' experience of the disease. The reinforcement of resilience factors, such as positive psychological traits, may also play a contributory role towards better patient outcomes.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - Eduardo Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra
| | | | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | - Marlene Sousa
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | | | | | | | - Miguel Guerra
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | | | - Inês Cordeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | | | - Patrícia Pinto
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | - Ana Margarida Pinto
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences.,Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - José António P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
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Pettersson H, Alexanderson H, Poole JL, Varga J, Regardt M, Russell AM, Salam Y, Jensen K, Mansour J, Frech T, Feghali-Bostwick C, Varjú C, Baldwin N, Heenan M, Fligelstone K, Holmner M, Lammi MR, Scholand MB, Shapiro L, Volkmann ER, Saketkoo LA. Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS). Best Pract Res Clin Rheumatol 2021; 35:101695. [PMID: 34217607 PMCID: PMC8478716 DOI: 10.1016/j.berh.2021.101695] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.
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Affiliation(s)
- Henrik Pettersson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Malin Regardt
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Russell
- University of Exeter, College of Medicine and Health, Exeter, UK; National Institute of Health Research, Senior Nurse Research Leader, London, UK
| | - Yasser Salam
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kelly Jensen
- Oregon Health and Science University, Portland, OR, USA; New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Jennifer Mansour
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Tracy Frech
- Vanderbilt University, Division of Rheumatology, Nashville, TN, USA
| | | | - Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | | | - Matty Heenan
- Scleroderma Foundation/Pulmonary Hypertension Association, Tucson, AZ, USA
| | - Kim Fligelstone
- Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Monica Holmner
- The Swedish Rheumatism Association National Association for Systemic Sclerosis, Sweden
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA
| | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA.
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10
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Murphy SL, Whibley D, Kratz AL, Poole JL, Khanna D. Fatigue Predicts Future Reduced Social Participation, not Reduced Physical Function or Quality of Life in People with Systemic Sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:187-193. [PMID: 34337153 PMCID: PMC8320783 DOI: 10.1177/2397198320965383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although fatigue is one of the most problematic symptoms for people with systemic sclerosis, little is known about how fatigue impacts daily life over time. Such information is important when developing fatigue management interventions. This study was conducted to examine 1) if fatigue severity predicted outcomes of worse functioning (social participation, physical function), and quality of life and 2) if level of self-efficacy moderated significant relationships between fatigue and these outcomes. METHODS Data were utilized from a clinical trial in which an online self-management intervention was tested (N = 267). Fatigue, social participation, and physical function were assessed by PROMIS measures. Quality of life was assessed by the EuroQol 5-domain instrument (EQ-5D-5L). Linear regressions were performed to examine how baseline fatigue related to functioning and quality of life outcomes 16 weeks later controlling for relevant covariates. PROMIS measures were used to measure self-efficacy in managing symptoms, daily activities, medications and treatments, emotions, and social interactions. RESULTS Fatigue at baseline significantly predicted social participation 16 weeks later; but did not predict physical functioning or quality of life. Self-efficacy variables did not moderate the association between fatigue and social participation. CONCLUSION Fatigue severity predicted decreased social participation in people with systemic sclerosis. Interventions targeting fatigue should include support to maintain participation of social roles and activities. The level of reported self-efficacy did not vary the strength of the association between fatigue and decline in social participation indicating that there may be other targets to treat fatigue intervention beyond self-management. TRIAL REGISTRATION NCT02494401.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and
Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Geriatric Research Education and
Clinical Center (GRECC), VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Daniel Whibley
- Epidemiology Group, School of Medicine,
Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- Department of Anesthesiology, Chronic
Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine and
Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Janet L Poole
- Department of Occupational Therapy,
University of New Mexico, Albuquerque, New Mexico, USA
| | - Dinesh Khanna
- Rheumatology Division, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Yakut H, Özalevli S, Birlik AM. Fatigue and its relationship with disease-related factors in patients with systemic sclerosis: A cross-sectional study. Turk J Med Sci 2021; 51:530-539. [PMID: 32927933 PMCID: PMC8203131 DOI: 10.3906/sag-2005-314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background/aim Fatigue is very common symptom in patients with systemic sclerosis (SSc) and adversely affects health-related quality of life and the ability to perform daily living activities. This study aimed to determine the severity of fatigue, and its related factors, in patients with SSc. Materials and methods A total of 35 patients with SSc (6 males and 29 females, mean age of 50.71 ± 10.09 years) and 35 healthy control subjects (8 males and 27 females, mean age of 54.14 ± 9.51 years) were included in this study. The Fatigue Impact Scale for fatigue, Modified Medical Research Council Scale for dyspnea severity, 6-Minute Walking Test for functional capacity, Health Assessment Questionnaire Disability Index, Scleroderma Health Assessment Questionnaire and Short Form-36 Quality of Life Questionnaire for health-related quality of life were used in the evaluation of the subjects. Furthermore, pulmonary functions, diffusion capacity, and respiratory and peripheral muscle strength were evaluated. Results Of the SSc patients, 80% experienced fatigue and presented with higher total and cognitive, physical, and psychosocial subscale fatigue scores than the healthy control subjects (P < 0.05). Moreover, the SSc patients exhibited significantly increased dyspnea severity, impaired pulmonary function-diffusion capacity, decreased respiratory-peripheral muscle strength, reduced functional capacity, and worsened health-related quality of life when compared to the control group (P < 0.05). Fatigue in the SSc group was significantly associated with age, dyspnea severity, diffusion capacity, respiratory and peripheral muscle strength, functional capacity, and health-related quality of life (P < 0.05). Conclusions Along with the decrease in diffusion capacity, increase dyspnea, a decrease in both peripheral and respiratory muscle strength, and worsening functional capacity may have an effect on increased fatigue in SSc patients. Increased fatigue can also affect the life quality and daily life activities of a patient. Therefore, multidisciplinary approaches are recommended to evaluate and improve these parameters in the treatment of fatigue from the early period in SSc patients.
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Affiliation(s)
- Hazal Yakut
- Department of Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Sevgi Özalevli
- Department of School of Physical Therapy and Rehabilitation, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Merih Birlik
- Department of Immunology and Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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12
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Murphy SL, Barber M, Huang S, Sabbagh M, Cutter G, Khanna D. Intensive and App-Delivered Occupational Therapy to Improve Upper Extremity Function in Early Diffuse Cutaneous Systemic Sclerosis: A Pilot Two-Arm Trial. Rheumatology (Oxford) 2021; 60:5002-5011. [PMID: 33839775 DOI: 10.1093/rheumatology/keab339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/05/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Systemic sclerosis (SSc) reduces upper extremity function and performance of everyday activities; however, there are few evidence-based rehabilitation interventions. This study examined short and longer-term effects of two occupational therapy interventions on hand disability. METHODS Participants with diffuse cutaneous SSc were randomized to one of two 18-week interventions: Intensive group, receiving 8-weekly in-person occupational therapy sessions with App-delivered home exercises, or App alone group. The primary outcome was QuickDASH hand disability; secondary outcomes were physical function (PROMIS scale), and total active hand motion. Linear mixed models were used to examine treatment effects. RESULTS Most participants were female (72%); the mean age was 52 years ± 13.4 (n = 32). There were no significant between-group effects on QuickDASH (p = 1.0; mean change -6.4 on 0-100 scale in both groups at 18 weeks). Left lateral pinch, an exploratory outcome, improved in App alone compared to Intensive from baseline to 18 weeks. Within groups, the intensive group had the largest improvements after 8 weeks (-8.5 on QuickDASH; p = 0.03), but then lost gains from 8 to 18 weeks while the App alone group had modest improvements from baseline to 8 weeks, but then continued to improve. Of completers, 50% had clinically meaningful improvement on QuickDASH in the Intensive group and 64% had improvement in App alone. CONCLUSION Both interventions showed beneficial effects on hand disability. Participants in the App alone group improved equally to the Intensive group at 18 weeks. Our findings provide support for further study into telehealth rehabilitation approaches.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA.,VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA
| | - Mary Barber
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Suiyuan Huang
- Division of Rheumatology, University of Michigan, Ann Arbor, MI USA
| | - Maya Sabbagh
- School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Gary Cutter
- School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI USA
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13
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Gheorghiu AM, Gyorfi H, Capotă R, Matei A, Oneaţă R, Bojincă M, Stoica V, Mihai C. Reliability, Validity, and Sensitivity to Change of the Cochin Hand Functional Disability Scale and Testing the New 6-Item Cochin Hand Functional Disability Scale in Systemic Sclerosis. J Clin Rheumatol 2021; 27:102-106. [PMID: 31703022 DOI: 10.1097/rhu.0000000000001195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disease causing complex hand disability. A reliable tool for hand function assessment in SSc is the Cochin Hand Functional Disability Scale (CHFS). More recently, a short-form CHFS of 6 items (CHFS-6) has been developed. OBJECTIVES To validate the CHFS and the new CHFS-6 in Romanian patients with SSc. PATIENTS AND METHODS Consecutive patients with SSc who completed the CHFS were included. All patients were assessed according to the recommendations of the European Scleroderma and Research Trials and also completed the Scleroderma Health Assessment Questionnaire and the Hand Mobility in Scleroderma questionnaire. Finger range-of-motion distances were measured. RESULTS Seventy patients, 63 female and 7 male patients (age median, 53.0 years; interquartile range [IQR], 21.0 years), were included. Twenty seven had diffuse cutaneous involvement (dcSSc). Median CHFS and CHFS-6 at baseline were 25.0 (IQR, 37.0) and 8.0 (IQR, 13.0), respectively.The internal consistency (Cronbach α = 0.96, respectively, 0.90, in all 70 patients) and test-retest reliability (intraclass correlation coefficient = 0.98 for both, in 38 patients) of both CHFS and CHFS-6 were excellent. The CHFS-6 had a very high correlation with the CHFS. There were moderate to good correlations with Hand Mobility in Scleroderma, Scleroderma Health Assessment Questionnaire, and the anthropometric measurements (construct validity). In patients with early dcSSc with a second evaluation, we found good to moderate sensitivity to change (standardized response mean of 0.8 and effect size of 0.4 for CHFS, and standardized response mean of 1.1 and effect size of 0.6 for CHFS-6). CONCLUSIONS The CHFS and CHFS-6 are valid and easy-to-use tools for hand involvement in SSc, which can be used in clinical or research setting.
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Affiliation(s)
| | - Hermina Gyorfi
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Răzvan Capotă
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Alexandru Matei
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Raida Oneaţă
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
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14
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Abstract
Work disability is highly prevalent in the systemic sclerosis (SSc) population; yet, it is an area of research that continues to be underrecognized and underexplored. In this chapter, we review the burden of this work disability by exploring the reported prevalence of work loss, the risk factors associated with reduced work participation, the impact on work productivity outcomes, and the economic consequences of work disability in individuals with SSc. Finally, we discuss the potential challenges in the workplace and strategies that may foster employment retention in this population. We subsequently present a conceptual framework for work disability in the context of SSc, which incorporates our understanding of the various work disability concepts and the potential facilitators that may accelerate a worker toward complete work loss.
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Affiliation(s)
- Jennifer J Y Lee
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Monique A M Gignac
- Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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15
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Murphy SL, Kratz AL, Whibley D, Poole JL, Khanna D. Fatigue and Its Association With Social Participation, Functioning, and Quality of Life in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2021; 73:415-422. [PMID: 31841268 DOI: 10.1002/acr.24122] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Fatigue is consistently ranked as one of the most problematic symptoms of systemic sclerosis (SSc), but the impact of fatigue on daily life is not well characterized. The purpose of this study was to examine the contribution of fatigue to deficits in social participation, functioning, and quality of life. METHODS Baseline data from a sample undertaking a clinical trial were utilized (n = 267). Fatigue, pain interference, depressive symptoms, physical function, and social participation were assessed by measures from the Patient-Reported Outcomes Measurement Information System. Hierarchical linear regressions were performed to determine the unique contribution of fatigue to social participation, physical function, and quality of life above and beyond the effects of demographic and clinical variables, pain interference, and depressive symptoms. RESULTS The sample was predominantly female (91%), with an average age of 53.7 years, average disease duration of 9 years, and a mean fatigue T score of 58.7. Of all outcomes, fatigue was most strongly associated with deficits in social participation, explaining 48% of the variance beyond demographic and clinical factors, which is similar to the amount of variance contributed by pain interference and depressive symptoms combined (49%). Fatigue also accounted for significant amounts of variance in physical function and quality of life (R2 = 0.27 and 0.33, respectively) above and beyond the effects of demographic and clinical factors. CONCLUSION Fatigue is an important clinical problem in SSc and is strongly associated with decreased participation in social roles and activities. Rehabilitation interventions that focus on fatigue management may be necessary to maximize participation.
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Affiliation(s)
- Susan L Murphy
- University of Michigan and Ann Arbor Veterans Affairs Health Care System, Ann Arbor, USA
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16
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Xiang L, Kua SM, Low AH. Work Productivity and Economic Burden of Systemic Sclerosis in a Multi-Ethnic Asian Population. Arthritis Care Res (Hoboken) 2020; 74:818-827. [PMID: 33253494 PMCID: PMC9314801 DOI: 10.1002/acr.24521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess work productivity, identify associated factors and evaluate the economic burden of systemic sclerosis (SSc) in a multi-ethnic Asian population. METHODS Data on employment status and work productivity loss were collected. Associations between demographic and disease characteristics and unemployment status, work productivity loss and activity impairment were examined using logistic and linear regression analyses, as appropriate. Costs of unemployment and work productivity loss were estimated using the human capital approach. RESULTS Of 111 patients with a mean disease duration of 9.1 years, 33 (29.7%) were unemployed. Their mean age at unemployment was 44.2 years, equating to 22.8 years of lost employment. No demographic and disease characteristics were significantly associated with unemployment status in multivariable analysis. Of 73 employed patients, 39 (53.4%) reported work productivity loss, accounting for 45.9% of the working week. Presence of hyperlipidemia (coefficient= -19.01, p=0.03) was associated with work productivity loss in multivariable analysis. Of 78 employed and 33 unemployed patients, 37 (47.4%) and 19 (57.6%) reported activity impairment, accounting for 42.2% and 50.0% of the preceding week, respectively. Presence of hyperlipidemia (coefficient= -18.56, p<0.01) was associated with activity impairment in multivariable analysis. Annual cost of unemployment and work productivity loss were estimated to be SGD$53,244 and SGD$13,045 per patient, respectively. CONCLUSION SSc imposes significant unemployment and work productivity loss and causes substantial economic burden to both affected individuals and society. Modifying the identified factors associated with unemployment and work productivity loss may reduce the burden of SSc.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sandra My Kua
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Andrea Hl Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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17
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Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Clin Rheumatol 2020; 39:1889-1898. [PMID: 31933034 PMCID: PMC7237402 DOI: 10.1007/s10067-019-04921-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023]
Abstract
Objectives It is suggested that exercise can improve the vascular function and quality of life (QoL) in people with systemic sclerosis (SSc), potentially offering clinical benefits to this population. Yet the feasibility of such an intervention remains untested. Therefore, the purpose of this study is to examine the feasibility of a combined exercise protocol (aerobic and resistance training) in people with limited cutaneous SSc (lcSSc). Methods Thirty-two lcSSc patients (66.5 ± 12 years old) were randomly allocated in two groups (exercise and control group). The exercise group underwent a 12-week exercise programme, twice per week. All patients performed the baseline, three- and six-month follow-up measurements where functional ability, body composition and QoL were assessed. Participants’ experiences were explored through interviews. Results Compliance was 92.6% with no dropouts. The individuals’ confidence to participate in the study’s exercise protocol for twice per week was 95%. The average value for the physical activity enjoyment scale was 103 ± 10 out of 119 (highest score). The mean values for the intention to engage in exercise twice per week were 6.4 ± 1 (likely) out of 7 (very likely). QoL for the exercise group showed to have a better life satisfaction, less anxiety and Raynaud’s phenomenon-accompanied pain. Conclusions Our results suggest that a combined exercise protocol was feasible for people with lcSSc, with no adverse events, resulting in high adherence and low attrition rates, high enjoyment levels and intentions for future engagement to this exercise. Thus, the specific protocol is a safe adjunct therapy for people with lcSSc. Trial registration:ClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017, https://clinicaltrials.gov/ct2/show/NCT03058887?term=NCT03058887&rank=1Key Points • High-intensity interval training in combination with resistance training constitutes a feasible exercise protocol for people with lcSSc. • Overall, the exercise programme demonstrated high adherence and enjoyment levels and low attrition rates. • The exercise protocol was proved to be safe with no adverse events for people with lcSSc. |
Electronic supplementary material The online version of this article (10.1007/s10067-019-04921-7) contains supplementary material, which is available to authorized users.
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18
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Murphy SL, Barber MW, Homer K, Dodge C, Cutter GR, Khanna D. Occupational Therapy Treatment to Improve Upper Extremity Function in Individuals with Early Systemic Sclerosis: A Pilot Study. Arthritis Care Res (Hoboken) 2019; 70:1653-1660. [PMID: 29381834 DOI: 10.1002/acr.23522] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the feasibility and preliminary effects of occupational therapy to improve upper extremity function in patients with early systemic sclerosis (SSc; scleroderma) who have upper extremity contractures. METHODS A single-group pilot clinical rehabilitation trial was conducted at the University of Michigan Scleroderma Center. Patients with SSc and ≥1 upper extremity contracture (n = 21) participated in a total of 8 weekly in-person occupational therapy sessions. The therapy consisted of thermal modalities, tissue mobilization, and upper extremity mobility exercises. The participants were instructed to perform upper extremity exercises at home between sessions. Feasibility was measured by the percent enrollment as well as session attendance and session duration. The primary outcome measure was the Shortened Disabilities of the Arm, Shoulder and Hand measure (QuickDASH); secondary and exploratory outcomes included the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function measures; objective measures of upper extremity mobility, strength, and coordination; and skin thickening. Linear mixed models were used to determine the effects of treatment on the primary and secondary outcomes. RESULTS Fifty percent of potentially eligible subjects (24 of 48) were interested in participating. Twenty-one (88%) of the 24 subjects were enrolled, and 19 (91%) of these 21 subjects completed all sessions. The mean ± SD age of the participants was 47.9 ± 16.1 years; 100% had diffuse SSc, and the mean disease duration was 3.1 years. At 8 weeks, participants had statistically significant improvement in the QuickDASH and PROMIS physical function measure (P = 0.0012 and P = 0.004, respectively). Approximately one-half of participants in the sample achieved improvement in the QuickDASH and PROMIS measure that exceeded minimally important differences. CONCLUSION In-person treatment sessions were feasible in the patients with SSc and resulted in statistically significant and clinically meaningful improvements in upper extremity and physical function. In future studies, the effects of SSc should be compared with those in a control condition, and the durability of treatment effects should be examined.
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Affiliation(s)
- Susan L Murphy
- University of Michigan and VA Ann Arbor Health Care System, Geriatric Research Education and Clinical Center, Ann Arbor, Michigan
| | | | - Kate Homer
- University of Michigan Scleroderma Center, Ann Arbor
| | | | | | - Dinesh Khanna
- University of Michigan Scleroderma Center, Ann Arbor
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19
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20
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Peytrignet S, Denton CP, Lunt M, Hesselstrand R, Mouthon L, Silman A, Pan X, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuta C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, Inanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Herrick AL. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study. Rheumatology (Oxford) 2018; 57:370-381. [PMID: 29207002 PMCID: PMC5850714 DOI: 10.1093/rheumatology/kex410] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features. Methods Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined. Results The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (s.d.) HAQ-DI 1.1 (0.83)], with ‘grip’ and ‘activity’ being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (ρ = 0.34, P < 0.0001 and ρ = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (ρ = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (ρ = 0.40, P < 0.0001), decreasing hand function (ρ = 0.57, P < 0.0001) and increasing fatigue (ρ = −0.53, P < 0.0001). Conclusion The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.
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Affiliation(s)
- Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularités Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Edith Brown
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | - Kim Fligelstone
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rachel Ochiel
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, Hôpital Saint-Louis, Paris, France
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Heath Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Wendy Stevens
- Rheumatology Unit, St Vincent's Hospital, Melbourne, Australia
| | - Pia Moinzadeh
- Department for Dermatology, University of Cologne, Köln, Germany
| | - Frances C Hall
- Department of Clinical Medicine, Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours, Tours, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Rheumatology, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Yasmeen Ahmad
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, UK
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander J MacGregor
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Neil McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | - Jennifer Hamilton
- Department of Rheumatology, Gateshead Hospitals Foundation Trust, Gateshead, UK
| | - Murat Inanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, Scotland, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
| | - Sanjay Pathare
- Rheumatology, James Cook University Hospital, Middlesbrough, UK
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | - Tom Sheeran
- Department of Rheumatology, Cannock Chase Hospital, Cannock, UK
| | - Douglas J Veale
- Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - Claire Grange
- Department of Internal Medicine 69310, Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France
| | - Georges-Selim Trad
- Internal Medecine, Ambroise Paré Hospital, Boulogne, Billancourt, France
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Mugii N, Hamaguchi Y, Maddali-Bongi S. Clinical significance and usefulness of rehabilitation for systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:71-80. [PMID: 35382125 PMCID: PMC8892873 DOI: 10.1177/2397198317750043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 07/30/2023]
Abstract
Systemic sclerosis is a multisystem connective tissue disorder characterized by excessive fibrosis of the skin and internal organs. Impairments in skin, the musculoskeletal system, and respiratory system require rehabilitation therapy because they may lead to disabilities and reduce the quality of life in daily activities. Rehabilitation for systemic sclerosis mainly comprises two distinct approaches that include local and global rehabilitation. Local rehabilitation is applied to maintain and/or improve hand and face functions, while global rehabilitation includes aerobic and resistance exercises. Although few high-quality randomized clinical trials have been conducted to date, previous studies indicated the effectiveness of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life. Rehabilitation for systemic sclerosis needs to be regularly and constantly performed at home as well as in hospitals. Physicians involved in the treatment of systemic sclerosis need to consider rehabilitation, and skilled physiotherapists and occupational therapists also play a crucial role in evaluating and treating systemic sclerosis patients.
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Affiliation(s)
- Naoki Mugii
- Department of Rehabilitation, Kanazawa
University Hospital, Kanazawa - Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, School of
Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa
University, Kanazawa - Japan
| | - Susanna Maddali-Bongi
- Rheumatological Rehabilitation Unit,
Division of General Rehabilitation, Department of Experimental and Clinical
Medicine, University of Florence, Florence - Italy
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22
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Morrisroe K, Sudararajan V, Stevens W, Sahhar J, Zochling J, Roddy J, Proudman S, Nikpour M. Work productivity in systemic sclerosis, its economic burden and association with health-related quality of life. Rheumatology (Oxford) 2017; 57:73-83. [PMID: 29155994 DOI: 10.1093/rheumatology/kex362] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate work productivity and its economic burden in SSc patients. Methods Consecutive SSc patients enrolled in the Australian Scleroderma Cohort Study were mailed questionnaires assessing employment (Workers' Productivity and Activity Impairment Questionnaire and a custom-made questionnaire) and health-related quality of life (HRQoL) (36-item Short Form Health Survey and Patient-Reported Outcomes Measurement Information System 29). Linear regression methods were used to determine factors associated with work productivity. Results Among 476 patients submitting responses, 55.2% <65 years of age were employed. Unemployed patients were older at the time of survey completion (57.1 vs 53.7 years; P < 0.001) and had longer disease duration from first SSc clinical manifestation (16.2 vs 14.9 years; P = 0.01) than employed patients. The mean age at unemployment onset was 13.2 years below the average Australian retirement age. Of those working in the week prior to completing the survey, 16.0% reported missing work (absenteeism) due to their SSc, accounting for 32.9% of their working week. Reduced productivity while at work (presenteeism) accounted for 22% of their working week. Annual costs per patient as a consequence of unemployment and reduced productivity equated to a total of AUD$67 595.40. Factors independently associated with reduced work productivity were presence of synovitis and sicca symptoms, while tertiary education protected against work impairment. Patients with low HRQoL scores also had low work productivity. Conclusion SSc is associated with considerable unemployment and reduced productivity, which in turn is associated with a substantial economic burden and poor HRQoL. Raising awareness and identifying modifiable factors are possible ways of reducing this burden.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Vijaya Sudararajan
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne
| | - Wendy Stevens
- Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Monash University, Clayton, VIC
| | - Jane Zochling
- Department of Rheumatology, Menzies Institute for Medical Research, Hobart, Tasmania
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, WA
| | - Susanna Proudman
- Royal Adelaide Hospital, Rheumatology Unit.,Department of Rheumatology, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
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23
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Controversies on the Use of Steroids in Systemic Sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017. [DOI: 10.5301/jsrd.5000234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of corticosteroids in patients with systemic sclerosis (SSc) always requires caution (especially because corticosteroids are a risk factor for scleroderma renal crisis [SRC]), and is often controversial. This review focuses on the main area of controversy, that is whether corticosteroids should be prescribed in patients with early diffuse cutaneous SSc (dcSSc). The arguments for and against corticosteroids in this clinical situation are presented, along with two case histories to illustrate the clinical dilemma. In favour of corticosteroids, is that these might suppress the musculoskeletal manifestations and itch that are so disabling in early disease, the argument against is that patients with early dcSSc are those at highest risk of SRC. That current opinion is divided amongst clinicians is evidenced by a roughly even split between patients previously prescribed and those not prescribed corticosteroids in the recent European Scleroderma Observational Study of early dcSSc (43% of 326 patients were on corticosteroids at their baseline visit or had previously been prescribed these). Other clinical situations in which corticosteroids may be considered in patients with SSc (mainly overlap syndromes and pulmonary involvement) are briefly discussed. Finally, some additional concerns relating to corticosteroid use specifically in patients with SSc are highlighted.
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24
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Sclérodermie systémique et difficultés professionnelles : résultats d’une enquête prospective. Rev Med Interne 2017; 38:718-724. [DOI: 10.1016/j.revmed.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/05/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
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McCormick N, Marra CA, Aviña-Zubieta JA. Productivity Losses and Costs in the Less-Common Systemic Autoimmune Rheumatic Diseases. Curr Rheumatol Rep 2017; 19:72. [PMID: 29086172 DOI: 10.1007/s11926-017-0698-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We synthesised the literature on productivity losses and costs in the less-common systemic autoimmune rheumatic diseases: Sjogren's syndrome (SjS), systemic sclerosis (SSc), poly/dermatomyositis (PM/DM), and systemic vasculitides (SV). RECENT FINDINGS Of 29 studies located, 12 were published 2012 onwards (SSc = 6, SjS = 2, PM/DM = 2, SV = 2). In these, 25% of PM/DM, and 21-26% of SV, were work disabled, 22% of SSc stopped work within 3 years of diagnosis, and annual costs of absenteeism in SSc averaged $12,024 2017 USD. Very few studies reported on costs, presenteeism (working at reduced levels), or unpaid productivity loss. Across multiple systemic autoimmune rheumatic diseases (SARDs), major drivers of lost productivity were generalised items like pain, depression, and fatigue, rather than disease-specific factors. Evidence suggests that work disability is common in SSc and strikes quickly. However, in SSc and other SARDs, more comprehensive estimates are needed, which include absenteeism and presenteeism from paid and unpaid work, costs, and drivers of productivity loss.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, BC, Canada.
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada.,Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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26
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Khanna D, Hays RD, Furst DE. Functional disability and other health-related quality-of-life domains: points to consider for clinical trials in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v17-v22. [PMID: 28992164 DOI: 10.1093/rheumatology/kex193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
Patients with SSc have the highest mortality among the rheumatic diseases. In addition, SSc is associated with disfigurement, hand contractures, fatigue, poor sleep, severe RP with numbness and tingling of the fingers can lead to decrements in quality of life. This Points to Consider article provides practical considerations for design of trials for functional disability and other health-related quality-of-life issues.
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Affiliation(s)
- Dinesh Khanna
- Department of Medicine, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI
| | - Ron D Hays
- Department of General Internal Medicine and Health Services Research
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27
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Tsouvaltzidou T, Alexopoulos E, Fragkakis I, Jelastopulu E. Upper extremity disorders in heavy industry workers in Greece. World J Orthop 2017; 8:478-483. [PMID: 28660140 PMCID: PMC5478491 DOI: 10.5312/wjo.v8.i6.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/30/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the disability due to musculoskeletal disorders of the upper extremities in heavy industry workers.
METHODS The population under study consisted of 802 employees, both white- and blue-collar, working in a shipyard industry in Athens, Greece. Data were collected through the distribution of questionnaires and the recording of individual and job-related characteristics during the period 2006-2009. The questionnaires used were the Quick Disabilities of the Arm, Shoulder and Hand (QD) Outcome Measure, the Work Ability Index (WAI) and the Short-Form-36 (SF-36) Health Survey. The QD was divided into three parameters - movement restrictions in everyday activities, work and sports/music activities - and the SF-36 into two items, physical and emotional. Multiple linear regression analysis was performed by means of the SPSS v.22 for Windows Statistical Package.
RESULTS The answers given by the participants for the QD did not reveal great discomfort regarding the execution of manual tasks, with the majority of the participants scoring under 5%, meaning no disability. After conducting multiple linear regression, age revealed a positive association with the parameter of restrictions in everyday activities (b = 0.64, P = 0.000). Basic education showed a statistically significant association regarding restrictions during leisure activities, with b = 2.140 (P = 0.029) for compulsory education graduates. WAI’s final score displayed negative charging in the regression analysis of all three parameters, with b = -0.142 (P = 0.0), b = -0.099 (P = 0.055) and b = -0.376 (P = 0.001) respectively, while the physical and emotional components of SF-36 associated with movement restrictions only in daily activities and work. The participants’ specialty made no statistically significant associations with any of the three parameters of the QD.
CONCLUSION Increased musculoskeletal disorders of the upper extremity are associated with older age, lower basic education and physical and mental/emotional health and reduced working ability.
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28
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Zanatta E, Rodeghiero F, Pigatto E, Galozzi P, Polito P, Favaro M, Punzi L, Cozzi F. Long-term improvement in activities of daily living in women with systemic sclerosis attending occupational therapy. Br J Occup Ther 2017. [DOI: 10.1177/0308022617698167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Systemic sclerosis often affects hand function, leading to severe disability in many subjects. There is little data available on the effects of occupational therapy in systemic sclerosis in current literature. The aim of our study was therefore to evaluate the effects of a cycle of occupational therapy on performing activities of daily living in a group of women with systemic sclerosis. Method Twenty women with systemic sclerosis were included in the study: 10 followed a cycle of occupational therapy; 10 were enrolled as controls. An occupational therapy cycle consisted of six meetings of 90 minutes each over a 3-week period. All women were evaluated by the Health Assessment Questionnaire and Evaluation of Daily Activity Questionnaire at baseline and after 24 weeks. The use of devices and alternative strategies was also assessed. Results We observed a significant reduction in the Health Assessment Questionnaire and Evaluation of Daily Activity Questionnaire scores in occupational therapy subjects after 6 months compared to controls. There was also evidence of significant improvement in four dimensions of the Evaluation of Daily Activity Questionnaire: eating; indoor mobility; outdoor mobility; and communication. The number of devices in the occupational therapy group increased significantly. Conclusion Our findings suggest a relevant role for occupational therapy in improving activities of daily living in women with systemic sclerosis. The use of strategies learned during occupational therapy sessions allows for long-lasting beneficial effects.
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Affiliation(s)
- Elisabetta Zanatta
- Resident, Rheumatology Unit, Department of Medicine – DIMED, University of Padova, Italy
| | | | - Erika Pigatto
- PhD Fellow in Clinical and Experimental Science, Department of Medicine – DIMED, University of Padova, Italy
| | - Paola Galozzi
- Post-doc Researcher, Rheumatology Unit, Department of Medicine – DIMED, University of Padova, Italy
| | - Pamela Polito
- Resident, Rheumatology Unit, Department of Medicine – DIMED, University of Padova, Italy
| | - Maria Favaro
- Outpatient Clinician, Department of Medicine – DIMED, University of Padova, Italy
| | - Leonardo Punzi
- Professor, Rheumatology Unit, Department of Medicine – DIMED, University of Padova, Italy
| | - Franco Cozzi
- Associated Professor, Rheumatology Unit, Department of Medicine – DIMED, University of Padova, Italy
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29
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Poole JL, Anwar S, Mendelson C, Allaire S. Workplace barriers encountered by employed persons with systemic sclerosis. Work 2016; 55:923-929. [DOI: 10.3233/wor-162448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Janet L. Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Sahar Anwar
- University of New Mexico Hospital, Albuquerque, NM, USA
| | - Cindy Mendelson
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Saralynn Allaire
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
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Sampaio‐Barros MM, Takayama L, Sampaio‐Barros PD, Bonfá E, Pereira RMR. Baixos níveis séricos de vitamina D na esclerose sistêmica difusa: correlação com pior qualidade de vida e alterações capilaroscópicas graves. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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31
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Low vitamin D serum levels in diffuse systemic sclerosis: a correlation with worst quality of life and severe capillaroscopic findings. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:337-44. [PMID: 27476627 DOI: 10.1016/j.rbre.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the correlation of vitamin D levels with clinical parameters, bone mineral density (BMD), quality of life (QoL) and nailfold capillaroscopy (NC) in patients with diffuse systemic sclerosis (SSc). METHODS Thirty-eight female patients with diffuse SSc were analyzed regarding 25-hydroxyvitamin D (25OHD) serum levels. At inclusion, organ involvement, autoantibodies, modified Rodnan skin score (mRSS), Medsger Disease Severity Index (MDSI), body mass index (BMI), BMD, NC, Short-Form-36 Questionnaire (SF-36), and Health Assessment Questionnaire (HAQ), were performed through a standardized interview, physical examination and electronic chart review. RESULTS Mean 25OHD serum level was 20.66±8.20ng/mL. Eleven percent of the patients had 25OHD levels ≤10ng/mL, 50% ≤20ng/mL and 87% ≤30ng/mL. Vitamin D serum levels were positively correlated with BMI (r=0.338, p=0.038), BMD-total femur (r=0.340, p=0.037), BMD-femoral neck (r=0.384, p=0.017), SF-36-Vitality (r=0.385, p=0.017), SF-36-Social Function (r=0.320, p=0.050), SF-36-Emotional Role (r=0.321, p=0.049) and SF-36-Mental Health (r=0.531, p=0.0006) and were negatively correlated with HAQ-Reach (r=-0.328, p=0.044) and HAQ-Grip Strength (r=-0.331, p=0.042). A negative correlation with NC-diffuse devascularization (p=0.029) and NC-avascular area (p=0.033) was also observed. CONCLUSION The present study provides novel evidence demonstrating that low levels of 25OHD have a negative impact in diffuse SSc QoL and further studies are needed to define whether vitamin D supplementation can improve health related QoL in these patients. The additional observation of a correlation with severe NC alterations suggests a possible role of 25OHD in the underlying SSc vascular involvement.
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Abstract
Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image.
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Affiliation(s)
- Cristiana Almeida
- Department of Medicine, Centro Hospitalar Vila Nova Gaia/Espinho (CHVNG/E), Gaia, Portugal.
| | - Isabel Almeida
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
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33
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Abstract
Patients with systemic sclerosis (SSc; also called scleroderma) have to cope with not only the physical impacts of the disease but also the emotional and social consequences of living with the condition. Because there is no cure for SSc, improving quality of life is a primary focus of treatment and an important clinical challenge. This article summarizes significant problems faced by patients with SSc, including depression, anxiety, fatigue, sleep disruption, pain, pruritus, body image dissatisfaction, and sexual dysfunction, and describes options to help patients cope with the consequences of the disease.
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Abstract
Background Hand–arm vibration exposure may cause hand–arm vibration syndrome (HAVS) including sensorineural disturbances. Aims To investigate which factors had the strongest impact on work ability in vibration-exposed workers. Methods A cross-sectional study in which vibration-exposed workers referred to a department of occupational and environmental medicine were compared with a randomized sample of unexposed subjects from the general population of the city of Gothenburg. All participants underwent a structured interview, answered several questionnaires and had a physical examination including measurements of hand and finger muscle strength and vibrotactile and thermal perception thresholds. Results The vibration-exposed group (47 subjects) showed significantly reduced sensitivity to cold and warmth in digit 2 bilaterally (P < 0.01) and in digit 5 in the left hand (P < 0.05) and to warmth in digit 5 in the right hand (P < 0.01), compared with the 18 referents. Similarly, tactilometry showed significantly raised vibration perception thresholds among the workers (P < 0.05). A strong relationship was found for the following multiple regression model: estimated work ability = 11.4 − 0.1 × age − 2.3 × current stress level − 2.5 × current pain in hands/arms (multiple r = 0.68; P < 0.001). Conclusions Vibration-exposed workers showed raised vibrotactile and thermal perception thresholds, compared with unexposed referents. Multiple regression analysis indicated that stress disorders and muscle pain in hands/arms must also be considered when evaluating work ability among subjects with HAVS.
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Affiliation(s)
- L Gerhardsson
- Occupational and Environmental Medicine, University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden.
| | - M Hagberg
- Occupational and Environmental Medicine, University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden
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35
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Nihtyanova SI, Schreiber BE, Ong VH, Rosenberg D, Moinzadeh P, Coghlan JG, Wells AU, Denton CP. Prediction of pulmonary complications and long-term survival in systemic sclerosis. Arthritis Rheumatol 2014; 66:1625-35. [PMID: 24591477 DOI: 10.1002/art.38390] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 01/28/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess survival and incidence of organ-based complications in a large single-center cohort of unselected systemic sclerosis (SSc) patients, and to explore predictors of survival and clinically significant pulmonary fibrosis (PF) and pulmonary hypertension (PH). METHODS The study cohort consisted of 398 consecutive SSc patients, followed up for up to 15 years. Cox proportional hazards analysis with demographic, clinical, and laboratory characteristics as predictor variables was used to develop prediction models for pulmonary complications and survival. RESULTS The overall survival estimate at the end of followup was 57% among patients with limited cutaneous SSc (lcSSc) and 50% among patients with diffuse cutaneous SSc (dcSSc) (P = 0.017). We found that greater age at disease onset, dcSSc, lower diffusing capacity for carbon monoxide (DLco), lower hemoglobin levels, higher serum creatinine levels, and the presence of PH or cardiac involvement were independent predictors of worse survival. Over the entire followup period, 42% of dcSSc patients and 22% of lcSSc patients developed clinically significant PF (P < 0.001). The variables that predicted clinically significant PF development were dcSSc, greater age at onset, lower forced vital capacity and DLco, and the presence of anti-topoisomerase I antibody, while the presence of anticentromere antibody was protective. There was no difference in cumulative incidence of PH between the 2 subsets-24% in lcSSc and 18% in dcSSc (P = 0.558). Incidence rates were 1-2% per year. The PH prediction model demonstrated that greater age at onset, increase in serum creatinine levels, lower DLco, and the presence of anti-RNA polymerase III or anti-U3 RNP antibodies were associated with increased risk of PH, while anti-topoisomerase I antibody positivity reduced the hazard. CONCLUSION Our study provides data on long-term outcome of SSc and the timing and frequency of major organ complications. The predictive models we present could be used as clinical tools for patient risk stratification and could facilitate cohort enrichment for event-driven studies.
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36
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Perrot S, Dieudé P, Pérocheau D, Allanore Y. Comparison of Pain, Pain Burden, Coping Strategies, and Attitudes Between Patients with Systemic Sclerosis and Patients with Rheumatoid Arthritis: A Cross-Sectional Study. PAIN MEDICINE 2013; 14:1776-85. [DOI: 10.1111/pme.12213] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Bérezné A, Nguyen C, Mouthon L. [Professional consequences of systemic sclerosis]. Presse Med 2013; 42:1159-70. [PMID: 23958211 DOI: 10.1016/j.lpm.2013.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/26/2013] [Accepted: 04/03/2013] [Indexed: 01/21/2023] Open
Abstract
Work disability is a major issue in patients with systemic sclerosis (SSc) and seems to be substantially higher than other connective tissue diseases. Working ability results from complex interactions between factors related to socio-demographic characteristics, SSc specificities and working conditions. Working ability is related to global disability, altered hand function, fatigue, pain, type of work and opportunities to adapt workstation. Work disability is responsible for reduced income in patients with SSc.
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Affiliation(s)
- Alice Bérezné
- Université Paris Descartes, faculté de médecine, Assistance publique-Hôpitaux de Paris, hôpital Cochin, service de médecine interne, centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, 75679 Paris, France.
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Baker NA, Aufman EL, Poole JL. Computer Use Problems and Accommodation Strategies at Work and Home for People With Systemic Sclerosis: A Needs Assessment. Am J Occup Ther 2012; 66:368-75. [DOI: 10.5014/ajot.2012.003467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We identified the extent of the need for interventions and assistive technology to prevent computer use problems in people with systemic sclerosis (SSc) and the accommodation strategies they use to alleviate such problems.
METHOD. Respondents were recruited through the Scleroderma Foundation. Twenty-seven people with SSc who used a computer and reported difficulty in working completed the Computer Problems Survey.
RESULTS. All but 1 of the respondents reported one problem with at least one equipment type. The highest number of respondents reported problems with keyboards (88%) and chairs (85%). More than half reported discomfort in the past month associated with the chair, keyboard, and mouse. Respondents used a variety of accommodation strategies.
CONCLUSION. Many respondents experienced problems and discomfort related to computer use. The characteristic symptoms of SSc may contribute to these problems. Occupational therapy interventions for computer use problems in clients with SSc need to be tested.
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Affiliation(s)
- Nancy A. Baker
- Nancy A. Baker, ScD, MPH, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, 6070 Forbes Tower, 3600 Forbes Avenue, Pittsburgh, PA 15260;
| | - Elyse L. Aufman
- Elyse L. Aufman, MOT, OTR/L, is Student, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Janet L. Poole
- Janet L. Poole, PhD, OTR/L, is Professor, Occupational Therapy Graduate Program, School of Medicine, University of New Mexico, Albuquerque, NM
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Schouffoer AA, Schoones JW, Terwee CB, Vliet Vlieland TPM. Work status and its determinants among patients with systemic sclerosis: a systematic review. Rheumatology (Oxford) 2012; 51:1304-14. [DOI: 10.1093/rheumatology/ker523] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ibn Yacoub Y, Amine B, Bensabbah R, Hajjaj-Hassouni N. Assessment of fatigue and its relationships with disease-related parameters in patients with Systemic sclerosis. Clin Rheumatol 2011; 31:655-60. [PMID: 22187224 DOI: 10.1007/s10067-011-1906-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 11/27/2011] [Accepted: 12/05/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Yousra Ibn Yacoub
- Department of Rheumatology (Pr N Hajjaj-Hassouni), El Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco.
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Chisholm-Burns MA, Erickson SR, Spivey CA, Kaplan B. Health-related quality of life and employment among renal transplant recipients. Clin Transplant 2011; 26:411-7. [DOI: 10.1111/j.1399-0012.2011.01541.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sandqvist G, Hesselstrand R, Scheja A, Hakansson C. Managing work life with systemic sclerosis. Rheumatology (Oxford) 2011; 51:319-23. [DOI: 10.1093/rheumatology/ker324] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Decuman S, Smith V, Verhaeghe S, Deschepper E, Vermeiren F, De Keyser F. Work participation and work transition in patients with systemic sclerosis: a cross-sectional study. Rheumatology (Oxford) 2011; 51:297-304. [PMID: 21972420 DOI: 10.1093/rheumatology/ker288] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe work participation and work transition due to health in patients with SSc. Associations are assessed between having made a work transition or not and factors possibly influencing that transition. METHODS This study included patients visiting the Scleroderma Clinic of the Ghent University Hospital, who regularly undergo an extensive evaluation. For this study, a questionnaire was used to collect work participation and work transition data. RESULTS Eighty-four patients in the adult working-age population were included. Thirty-eight (45%) out of 84 patients participated in the labour force. Forty-six (55%) out of 84 were not engaged in a paid job; in 34 (74%) out of 46 patients this was attributed to health issues. Seventy-six (90%) out of 84 patients made a work transition. Forty-seven (62%) out of 76 made that transition due to health reasons. The group that made a health-related work transition (47/84, 56%) was compared with the remaining group (37/84, 44%) that made no work transition or a work transition for reasons other than health. There was a significant difference in educational level, skin score, lung disease severity, disease activity, disease duration, scleroderma Health Assessment Questionnaire (sHAQ), visual analogue scale (VAS) for RP, VAS for intestinal disease, VAS for overall disease, VAS for pain, Medical Outcomes Study short form 36 (SF-36), work statute and willingness to participate in training. The multivariate analysis retained sHAQ, SF-36 and disease duration as associating variables. CONCLUSIONS Work participation is limited in patients with SSc and a majority make a work transition because of health problems. Demographic, disease- and work-related variables, as well as willingness to participate in training are associated with (the occurrence of) work transition.
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Affiliation(s)
- Saskia Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Sandqvist G, Archenholtz B, Scheja A, Hesselstrand R. The Swedish version of the Multidimensional Assessment of Fatigue (MAF) in systemic sclerosis: reproducibility and correlations to other fatigue instruments. Scand J Rheumatol 2011; 40:493-4. [DOI: 10.3109/03009742.2011.605395] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sharif R, Mayes MD, Nicassio PM, Gonzalez EB, Draeger H, McNearney TA, Estrada-Y-Martin RM, Nair DK, Reveille JD, Arnett FC, Assassi S. Determinants of work disability in patients with systemic sclerosis: a longitudinal study of the GENISOS cohort. Semin Arthritis Rheum 2011; 41:38-47. [PMID: 21429562 DOI: 10.1016/j.semarthrit.2011.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/01/2011] [Accepted: 01/04/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine the prevalence, correlates, and predictors of work disability (WD) in the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS). We hypothesized that WD in systemic sclerosis (SSc) is a function of demographic, clinical, and psychosocial factors. METHODS Patients enrolled in the GENISOS cohort were subdivided in 3 groups: work disabled, working, and retired or homemakers. The latter group (n = 29) was excluded from further analysis. We used logistic regression analysis with a forward hierarchical variable selection strategy to investigate the independent correlates of WD at enrollment. Cox regression proportional Hazard's model with a similar variable selection strategy was utilized to determine the predictors of WD in those working at enrollment. RESULTS Overall, 284 patients with a mean age of 48.7 years and disease duration of 2.5 (±1.6) years were enrolled into the GENISOS cohort, consisting of 83.5% female, 46.8% white, 28.9% Hispanic, and 20.4% African American. Patients were longitudinally followed in 1438 study visits. At enrollment, 124 patients (43.7%) were work disabled, whereas 131 (46.1%) were working. Lower level of education (P < 0.001), higher Medsger Lung Severity Index (P = 0.012), higher Fatigue Severity Score (P = 0.008), and less social support (P < 0.001) correlated independently with WD. Of those working at baseline, 35 (26.7%) eventually developed WD. Non-white ethnicity (P = 0.038), lower DLCO % predicted value (P = 0.038), and higher Fatigue Severity Score (P = 0.009) at enrollment independently predicted WD on follow-up visits. CONCLUSIONS WD is a major problem among SSc patients and its prevalence is substantially higher than other rheumatic conditions. Demographic, clinical, and psychosocial factors correlate with WD cross-sectionally and predict WD longitudinally in these patients.
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Affiliation(s)
- Roozbeh Sharif
- Division of Rheumatology and Immunogenetics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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