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OBJECTIVE: To assess clinical factors associated with disability and physical health in patients with systemic sclerosis (SSc) compared to psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) and healthy controls. METHODS: Eighty-two patients with SSc, 82 with PsA, 74 with SLE, 42 with RA, and 60 controls were recruited from various rheumatology clinics and underwent physical examination, tender point count, Health Assessment Questionnaire Disability Index (HAQ-DI) and Short Form-36 Health Survey (SF-36) assessments. RESULTS: SSc patients were younger and had shorter disease duration than the comparator groups. SSc patients with joint involvement had significantly poorer HAQ-DI scores than patients with PsA (1.43 vs 0.84; p < 0.05), and had higher visual analog scale pain scores than RA patients (1.37 vs 1.01; p < 0.05). The SF-36 Physical Component Summary and HAQ-DI score in SSc patients were adversely affected by joint involvement (p < 0.01, p < 0.001, respectively), >or= 11 tender points (p < 0.01, p < 0.001), gastrointestinal (GI) involvement (p < 0.01, p < 0.01), and high skin score (p = 0.02, p < 0.001). CONCLUSION: Physical health relating to quality of life is adversely affected in patients with SSc. Disability is associated with the presence of >or= 11 tender points, a high skin score, and joint and GI involvement. Joint involvement in SSc is more disabling than joint involvement in PsA; and patients with SSc experience more severe pain than patients with RA.