Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Clin Rheumatol. 2020 May;39(5):1543-1549. doi: 10.1007/s10067-020-04951-6. Epub 2020 Jan 24.
In systemic sclerosis (SSc) therapeutic efforts are often directed to prevent progressive respiratory impairment, but it is unclear to what extent changes in pulmonary function tests (PFTs) are associated with health-related quality of life (HRQoL). The aim of our study is to evaluate how modifications in PFTs contribute to longitudinal variations in HRQoL, assessed through the multidimensional questionnaire EQ-5D, in patients with SSc. We included SSc patients with forced vital capacity (FVC%), diffusing capacity of the lungs for carbon monoxide (DLCO%) and EQ-5D assessed in at least two visits. The EQ-5D consists of two parts, a utility score ranging from - 0.59 to 1, and a 0-100 Visual Analogue Scale (VAS). Higher values represent better health. The association between changes in FVC% and DLCO%, and evolution of EQ-5D over time, was investigated using generalized estimating equations. Three hundred seventy-eight patients were included, accounting for a total of 1619 measurements. The models showed that improvement in FVC% is significantly associated with increase in both utility score (β = 0.001; 95% CI 0.000 to 0.002; p = 0.003) and VAS over time (β = 0.188; 95% CI 0.111 to 0.264; p < 0.001). Moreover, improvement in DLCO% is longitudinally associated with increase in utility score (β = 0.001; 95% CI 0.000 to 0.002; p = 0.038), while the results for VAS were non-significant (β = 0.020; 95% CI -0.079 to 0.120; p = 0.690). We show that change in PFTs has a significant, although minor, impact on HRQoL as measured by EQ-5D in SSc.Key Points• In patients with SSc, changes in PFTs have a significant, although minor, impact on HRQoL.• In patients with SSc-ILD, the perception of HRQoL is nearly not influenced by changes in pulmonary function.• The use of generic questionnaires might not be sensitive enough to evaluate the impact on quality of life of therapies targeting specific SSc manifestations.
在系统性硬化症 (SSc) 中，治疗的重点通常是预防进行性呼吸损伤，但尚不清楚肺功能检查 (PFT) 的变化在多大程度上与健康相关的生活质量 (HRQoL) 相关。我们研究的目的是评估 PFT 的变化如何导致 SSc 患者通过多维问卷 EQ-5D 评估的 HRQoL 的纵向变化。我们纳入了至少两次就诊时评估用力肺活量 (FVC%)、一氧化碳弥散量 (DLCO%) 和 EQ-5D 的 SSc 患者。EQ-5D 由两部分组成，一个范围为 -0.59 至 1 的效用评分和一个 0-100 的视觉模拟量表 (VAS)。更高的值表示更好的健康状况。使用广义估计方程研究 FVC%和 DLCO%变化与 EQ-5D 随时间的演变之间的关系。纳入了 378 名患者，共进行了 1619 次测量。模型表明，FVC%的改善与效用评分的增加显著相关（β=0.001；95%CI 0.000 至 0.002；p=0.003）和 VAS 随时间的增加（β=0.188；95%CI 0.111 至 0.264；p<0.001）。此外，DLCO%的改善与效用评分的增加呈纵向相关（β=0.001；95%CI 0.000 至 0.002；p=0.038），而 VAS 的结果无统计学意义（β=0.020；95%CI -0.079 至 0.120；p=0.690）。我们表明，在 SSc 中，PFT 的变化对 EQ-5D 测量的 HRQoL 有显著但较小的影响。
