Anxiety disorders are an important determinant of quality of life in systemic sclerosis patients

Background: In the absence of a treatment, the HRQol is now considered as an important outcome in SSc and as a tool to evaluate the efficacy of therapy. The objective of this study was to investigate district disability and anxiety along with those other factors (such as fatigue, self-esteem, coping styles, global disability and depression) already previously assessed as predictors of HRQol in SSc patients. Methods: 119 SSc patients, 74 with limited SSc (lSSc) and 45 with diffuse SSc (dSSc), were administrated by Short Form-36 health survey (SF36), Hospital Anxiety Depression Scale (HADS), Health Assessment Questionnaire (HAQ). Patients were also assessed for psychological symptoms (RSES, COPE-NIV), hand disability (HAMIS, CHFDS, fist closure, hand opening), face disability (MHISS, mouth opening) and fatigue (FACIT). We created HRQol model which assumes that disease characteristics and psychological symptoms might influence HRQol either directly, or indirectly acting on global disability, depression and anxiety which are ultimately influencing HRQol in SSc patients. Such influence has been assessed on both the mental and physical dimension. In the final Physical and Mental HRQol Models the only the most contributing factors were present. Results In multivariate regression analysis, the significant predictors of SPI of SF-36 were fatigue (p<0.001) and hands disability (HAMIS) ( p<0.001), accounting for 43,7% of the variance in SPI. The significant predictors of SMI of SF-36 were fatigue (p=0.001), avoidance strategy coping style (p=0.016) and anxiety (p<0.001), accounting for 52,8% of the variance in SMI. Independent predictors of anxiety (mouth disability, self-esteem and social support) were included in the final model for Mental component of Quality of life (SMI) as factors which may affect SMI of SF-36 indirectly (by increasing of anxiety). Conclusions: Hands and face disability, fatigue and psychological symptoms are important factors contributing to HRQol in SSc patients. Assessment of local disability and psychological evaluation of SSc patients may help to identify targets and the ability to improve their HRQol.