The effects of mouth opening on quality of life, anxiety level, and body image in patients with systemic sclerosis

ABSTRACT The Effects of Mouth Opening on Quality of Life, Anxiety Level, and Body Image in Patients with Systemic Sclerosis Objective: Systemic sclerosis (SSc) is a connective tissue disease that affects multiple organs and is characterized by fibrosis and vasculopathy of the skin and internal organs. Aesthetic and functional alterations in the physical appearance of patients with SSc may have an impact on their psychological well-being and overall quality of life. The aim of this study was to investigate the relationship between psychological variables, quality of life, disease activity, and mouth opening in patients with SSc. As a result of the study, it was aimed to evaluate the quality of life and psychological status of SSc patients in routine follow-up and to provide multidisciplinary examination. Materials and Methods: Ninety-nine patients with the diagnosis of SSc admitted to the Department of Rheumatology and Immunology, Balcalı Hospital, Çukurova University Faculty of Medicine, were included in the study. The patient group to be included in the study was informed and an informed consent form was obtained. Age, gender, history of additional chronic and psychological disorders at the time of the last admission were recorded. The Mouth Handicap in Systemic Sclerosis (MHISS-T), Social Appearance Anxiety Scale (SAAS), World Health Organization Quality of Life Short Form (WHOQOL-BREF), Hospital Anxiety and Depression Scale (HADS), and Psychological Resilience scales were used. The dermal skin thickness was calculated using the Modified Rodnan Skin Score (MRSS). Eustar Activity Index (EAI) was calculated. Statistical analysis was performed using SPSS 25.0 package program. Results: Patients with diffuse systemic sclerosis had higher MHISS-T scores than patients with limited systemic sclerosis (p<0,001). A significant correlation was found between the MHISS-T score and hemoglobin, hematocrit, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO) and sedimentation values (p<0,05). A significant correlation was found between the history of iloprost treatment use in the last year, telangiectasia, calcinosis, sclerodactyly, weight loss, arthritis, digital ulcer, organ involvement, interstitial lung disease and gastrointestinal system involvement and MHISS-T (p<0,05). There was a significant correlation between MRSS-Total score, MRSS-Face score and MHISS-T score (p<0,05). A significant correlation was found between SAAS, HADS Anxiety score, HADS Depression score, WHOQOL-BREF, Psychological Resilience scale, EAI and MHISS-T (p<0,05). Conclusion: Morphological changes occur in the external appearance of SSc patients during the disease period. These changes have an impact on patient psychology and quality of life. In our study, the most important factors affecting MHISS-T in patients with SSc were MRSS-Total score and SAAS. More comprehensive studies are needed for more detailed information. Patients with SSc should be evaluated for mouth opening handicap at every outpatient visit and multidisciplinary examination should be provided. We recommend that these and similar parameters be studied in larger patient groups. Keywords: Systemic Sclerosis, MHISS-T, Quality of Life, Social Appearance Anxiety, Psychological Resilience, Eustar Activity Index