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J Rheumatol. 2019 Mar 1. pii: jrheum.180818. doi: 10.3899/jrheum.180818. [Epub ahead of print]

Factors influencing Raynaud's condition score diary outcomes in systemic sclerosis.

Author information

1
From the Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, Bath, UK; Department of Mathematical Sciences, University of Bath, Bath, UK; University of Utah and Salt Lake Regional Veterans Affair Medical Center, Salt Lake City, Utah, United States of America. Address correspondence to Dr John D Pauling BMedSci BMBS PhD FRCP, Senior Lecturer & Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL. Email: JohnPauling@nhs.net.

Abstract

OBJECTIVE:

Raynaud's phenomenon (RP) in systemic sclerosis (SSc) could be influenced by clinical phenotype, environmental factors e.g. season and personal factors e.g. coping strategies and ill-health perceptions. We explored the relative influence of a range of putative factors affecting patient-reported assessment of SSc-RP severity.

METHODS:

SSc patients were enrolled at UK and US sites. Participants completed the 2-week Raynaud's Condition Score (RCS)-diary alongside collection of patient demographics, clinical phenotype, the Coping Strategies Questionnaire, Pain Catastrophisation Scale, Scleroderma Health Assessment Questionnaire (SHAQ) and both patient/physician visual analogue scale (VAS) assessments for RP, digital ulcer disease and global disease. Environmental temperature data was obtained at each site. A second RCS-diary was completed 6-months after enrolment.

RESULTS:

We enrolled 107 patients (baseline questionnaires returned by 94). There were significant associations between RCS-diary parameters and both catastrophisation and coping strategies. There were significant associations between RCS-diary outcomes and both environmental temperature and season of enrolment. Age, disease duration, sex, disease subtype, smoking and vasodilator use were not associated with RCS-diary outcomes. The best fitting multivariate model identified the patient RP VAS, the SHAQ pain VAS and the SHAQ gastrointestinal VAS subscales as the strongest independent predictors of the RCS score.

CONCLUSION:

Patient-reported assessment of SSc-RP severity is associated with a number of factors including pain, catastrophisation and coping strategies. The effects of seasonal variation in environmental temperature on SSc-RP burden has implications for clinical trial design. Treatments targeting SSc-RP pain and the development of behavioural interventions enhancing coping strategies may reduce the burden of SSc-RP.

PMID:
30824643
DOI:
10.3899/jrheum.180818

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