Medical signs and symptoms associated with disability, pain, and psychosocial adjustment in systemic sclerosis.

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.