Hopelessness is associated to severity of both digital vasculopathy and lung disease in systemic sclerosis patients: a prospective one-year study

Abstract

Objectives: Systemic sclerosis (SSc) is an autoimmune fibrosing disease with multi-organ involvement, significantly impacting quality of life. This study assessed the burden of hopelessness and its clinical and psychosocial correlates in SSc patients.

Methods: 76 SSc patients were followed prospectively over one year. Clinical assessments included Medsger Severity Score (MSS), disease activity (revised EUSTAR Activity Index), modified Rodnan skin score (mRSS), and digital ulcer (DU) presence and severity (DUCAS), Hand disability (HAMIS), Raynaud diary, and Raynaud's Condition Score (RCS). Psychosocial measures included the Beck Hopelessness Scale (BHS), 36-Item Short Form Survey (SF-36), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Body Image Scale (BIS). Patients were stratified by BHS into mild (≤8) and moderate/severe (>8) hopelessness.

Results: SSc patients had significantly higher BHS scores than controls (p<0.001). Moderate/severe hopelessness was linked to more severe disease (MSS: BHS>8 = 6 [4-10] vs. ≤8 = 3 [2-5], p=0.008) and worse MSS lung scores over time (p<0.05). BHS>8 was also associated with poorer HAMIS, RCS, and ADL function. Multivariate analysis showed significant associations between hopelessness and MSS lung scores (Coeff = 0.490, CI [0.030-0.957], p=0.037), RCS (Coeff = 0.180, CI [0.029-0.329], p=0.019), and BIS (Coeff = 0.229, CI [0.165-0.292], p<0.001). In SSc patients with active DU, hopelessness correlated with DUCAS (Coeff =0.636, CI [0.033-1.239], p=0.039).

Conclusions: Hopelessness is common in SSc and linked to lung severity and digital vasculopathy, highlighting the importance of targeting hand function and pulmonary disease to improve psycho-social wellbeing.