Effects of skin involvement on quality of life and investigation of related factors in systemic sclerosis

Introduction: Systemic sclerosis (SSc) is a rare rheumatologic disease characterized by vasculopathy, fibrosis, and immune dysregulation. Skin is the most frequently affected organ in SSc. To assess skin involvement, the modified Rodnan skin score (mRSS) is commonly utilized. In our study, we aimed to thoroughly investigate the factors influencing skin involvement and the patients' perception of their skin condition. Materials and Methods: Our study was conducted on 66 patients with SSc who applied to the Rheumatology Outpatient Clinic of the Internal Medicine Department at Manisa Celal Bayar University. The extent of skin involvement in patients was assessed using the modified Rodnan skin score (mRSS). The impact of skin involvement on quality of life was evaluated with the Turkish version of the Scleroderma Skin Patient-Reported Outcome (SSPRO) questionnaire. Changes in overall quality of life were assessed using the Turkish version of the Health Assessment Questionnaire. Demographic information, clinical characteristics, antibody profiles, and organ involvement of the patients were recorded. Results: Of the patients, 62 (93.9%) were female, and 4 (6.1%) were male, with a mean age of 54.9 ± 10.3 years and a median disease duration of 9.3 ± 6.21 years. The majority of patients had the limited cutaneous SSc (lcSSc) subtype (62.1%). The mean MRSS was significantly higher in diffuse cutaneous SSc (dcSSc) compared to lcSSc (27.7 vs. 15.6; p<0.001). SSPRO and HAQ scores were found to be higher in dcSSc patients than in lcSSc patients (SSPRO: 63.08 vs. 44.9, p=0.001; HAQ: 1.09 vs. 0.61, p=0.001). Moderate positive correlations were observed between MRSS and both SSPRO and HAQ (R=0.538 and R=0.506 respectively, p<0.001). Anti-Scl70 positivity was associated with higher MRSS, SSPRO, and HAQ scores, whereas Anti-Sm/RNP positivity was associated with lower scores. Among clinical findings, telangiectasia and pulmonary arterial hypertension (PAH) significantly impacted quality of life scores. Conclusion: Skin involvement significantly affects the quality of life. While mRSS is clinician-dependent and may fall short in reflecting patients' perception and burden of the disease, questionnaires like the SSPRO, designed to mirror the impact of skin involvement on quality of life, can be more frequently utilized in daily practice to help us determine the disease burden.