Clinical and psychosocial determinants of oral handicap in systemic sclerosis: a cross-sectional study

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Abstract
To examine the relationship between oral handicap, clinical characteristics, psychosocial status, and quality of life in patients with systemic sclerosis (SSc). This cross-sectional study included 99 patients with SSc. Oral handicap was assessed using the Mouth Handicap in Systemic Sclerosis Scale (MHISS). Social appearance anxiety, anxiety/depression symptoms, resilience, and quality of life were evaluated using the Social Appearance Anxiety Scale, Hospital Anxiety and Depression Scale, Brief Resilience Scale, and World Health Organization Quality of Life–BREF (WHOQOL-BREF), respectively. Statistical and hierarchical multiple regression analyses were also performed. Oral handicap was associated with female sex (rho = 0.220, p = 0.029) and diffuse cutaneous SSc subtype (rho = − 0.482, p < 0.001). Oral handicap showed strong positive correlations with the facial and total modified Rodnan Skin Score (rho = 0.851 and rho = 0.737; both p < 0.001). Positive associations were also observed for gastrointestinal (GI) involvement, calcinosis, telangiectasia, Scl-70 positivity, and digital ulcers (p < 0.002 for all). MHISS scores were positively correlated with anxiety, depression, and social appearance anxiety, and negatively correlated with all WHOQOL-BREF domains (p < 0.001 for all). In the regression analyses, mRSS (β = 0.484, p < 0.001), GI involvement (β = 0.210, p = 0.006), and anxiety scores (β = 0.183, p = 0.036) remained independently associated with oral impairment. The clinical model explained an additional 54% of variance, with a further 5% contributed by psychosocial variables. Oral impairment in SSc reflects both clinical disease burden and psychosocial distress, underscoring its multifactorial nature.
Funding Information
  • Çukurova University

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