Systemic sclerosis & Raynaud's
Investigating the trajectory of functional disability in systemic sclerosis: group-based trajectory modelling of the Health Assessment Questionnaire-Disability Index
Authors' conclusion
Two trajectories of functional disability in SSc were identified. Those with high-increasing functional disability had a distinct clinical phenotype and worse survival compared to those with low-stable functional disability.
Study context
- Population
- Australian Scleroderma Cohort Study (ASCS) participants meeting ACR/EULAR criteria for systemic sclerosis (SSc), recruited within 5 years of disease onset, with ≥2 Health Assessment Questionnaire-Disability Index (HAQ-DI) scoresincident SSc
- Participants
- 426 participants
- Exposure
- High-increasing vs low-stable HAQ-DI disability trajectory
- High-increasing disabilityn = 205
- Low-stable disabilityn = 221reference
- Outcome
- Trajectories of functional disability (HAQ-DI) and their clinical associations
Methodological detailsgroup-based trajectory modelling, multiple logistic regression, Cox proportional hazard modelling
- Group-based trajectory modelling
- Multiple logistic regression
- Cox proportional hazard modelling
Main finding
As reported in the abstract
HAQ-DI trajectory groups
Observational data: associations, not effects.
Further findings
Features associated with high-increasing trajectory membership
| OR (95% CI) | P value | ||
|---|---|---|---|
| Multimorbidity | 3.1 (1.1–8.8) | P = 0.04 | |
| dcSSc | 2.3 (1.3–4.2) | P < 0.01 | |
| Proximal weakness | 7.3 (2.0–27.1) | P < 0.01 | |
| Joint contractures | 2.7 (1.3–5.3) | P < 0.01 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Mortality | 1.9 (1.0–3.8) | P = 0.05 | |
| 0.20.5125Hazard ratio (log scale) |
Features associated with high-increasing trajectory membership
- High-increasing: older at onset, more dcSSc, cardiopulmonary disease, multimorbidity, digital ulcers, GI involvement (all p≤0.01) and immunosuppression use (p<0.01)
Mortality
- Higher symptom burden with high-increasing disability
Original publication
Investigating the trajectory of functional disability in systemic sclerosis: group-based trajectory modelling of the Health Assessment Questionnaire-Disability Index. Clin Exp Rheumatol. Published 2 August 2024. doi:10.
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