PT  - JOURNAL ARTICLE
AU  - Vanessa L Malcarne
AU  - Ingunn Hansdottir
AU  - Ann McKinney
AU  - Renn Upchurch
AU  - Helen L Greenbergs
AU  - Gretchen H Henstorf
AU  - Daniel E Furst
AU  - Philip J Clements
AU  - Michael H Weisman
TI  - Medical signs and symptoms associated with disability, pain, and psychosocial adjustment in systemic sclerosis.
DP  - 2007 Feb 01
TA  - The Journal of Rheumatology
PG  - 359--367
VI  - 34
IP  - 2
4099  - http://www.jrheum.org/content/34/2/359.short
4100  - http://www.jrheum.org/content/34/2/359.full
SO  - J Rheumatol2007 Feb 01; 34
AB  - OBJECTIVE: To examine physician-assessed medical signs and patient-reported medical symptoms as correlates of 3 quality of life (QOL) outcomes in patients with systemic sclerosis (SSc): disability, pain, and psychosocial adjustment. METHODS: One hundred fourteen patients with SSc underwent a comprehensive clinical examination including determination of skin thickening [Modified Rodnan Skin Score (MRSS)]. Patients reported current symptoms and completed standardized questionnaires assessing disability and pain (Health Assessment Questionnaire) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale). Regression analysis was used to examine physician-determined and patient-reported correlates of the 3 outcomes. RESULTS: MRSS was a significant correlate of all outcomes, although it explained only a small amount of the variance in psychosocial adjustment. Patient-reported postprandial bloating was the strongest correlate of psychosocial adjustment, explaining more than twice as much variance as MRSS. After accounting for MRSS, patient-reported dependent edema significantly correlated with all outcomes. For disability, significant correlates were physician-determined joint tenderness and number of tender points, and patient-reported joint pain on motion, joint contracture, extremity ulcers other than digital, and dyspnea. Patient-reported joint tenderness was significantly associated with pain. Regression analysis supported a model in which disability and pain mediated the relationship between MRSS and psychosocial adjustment. CONCLUSION: Skin score is strongly associated with disability and pain, but only weakly associated with psychosocial adjustment. Dependent edema has negative implications across quality-of-life outcomes. Disability and pain mediate the relationship between disease severity and psychosocial adjustment to disease. Assessment (including self-report of patient symptoms) of specific medical signs and symptoms may indicate SSc patients experiencing diminished QOL.