Vrancianu Cristina A, Grigore Cristiana, Ancuta Ioan, Bojinca Mihai, Gheorghiu Ana Maria
Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital, 020475 Bucharest, Romania.
J Clin Med. 2025 Jul 5;14(13):4764. doi: 10.3390/jcm14134764.
Systemic sclerosis (SSc) is a multisystemic chronic autoimmune disease, which leads to disability and possibly early retirement. The objective of our study was to explore the associations between employment status (ES) and demographic, clinical and functional features in a single-center EUSTAR cohort. Consecutive patients with SSc examined between November 2011 and June 2023, who were under the age of retirement in our country (62 years for women, 65 for men at the time), were included. All patients underwent a comprehensive clinical assessment and filled in a work assessment questionnaire as well as two validated health-related questionnaires: the Scleroderma Health Assessment Questionnaire (SHAQ) and the Duruoz Hand Index (DHI). Associations between ES and potential predictors (education level, disease characteristics, work conditions, SHAQ and DHI) were tested using logistic regression adjusted for age and gender. Ninety-one patients (mean ± SD age 53.7 ± 11.8 years, twenty-two with diffuse skin involvement, fifty-six with a history of digital of digital ulcers (DUs)), were included. Only 22 patients were still employed, while 69 were retired, of which 38 retired because of SSc. Among the employed, nine performed manual labor, nine spent many hours standing and three had to work in a cold environment. When potential predictors were tested separately, adjusted for age and sex, patients with higher education (OR (95% CI) 11.36 (2.03-63.36), = 0.006) and no history of digital ulcers had higher odds of being employed. The presence of joint contractures and weightlifting as a work demand were associated with unemployment. In a multivariable model, higher education (OR 5.91, 95% CI 0.97-36.09, = 0.054 and younger age (OR 0.90, 95% CI 0.85-0.96, = 0.001) were independently associated with continued employment. High school education did not show a significant effect (OR 0.089, 95% CI 0.015-0.530, = 0.008). Patients with a history of digital ulcers had the lowest employment rates compared to those with no digital ulcer history. No significant associations were found between employment status and SHAQ or DHI scores. SSc is associated with significant work disability and early retirement. Higher education, the lack of Dus and younger age were highly associated with staying employed. Given the rarity of SSc, we consider that our good sample size = 91) reflects disease prevalence, but results should be tested in other studies and the single center should be considered when interpreting generalizability.
系统性硬化症（SSc）是一种多系统慢性自身免疫性疾病，可导致残疾并可能提前退休。我们研究的目的是在一个单中心的EUSTAR队列中探讨就业状况（ES）与人口统计学、临床和功能特征之间的关联。纳入了2011年11月至2023年6月期间在我国接受检查的连续SSc患者，这些患者未达到退休年龄（当时女性为62岁，男性为65岁）。所有患者均接受了全面的临床评估，并填写了工作评估问卷以及两份经过验证的与健康相关的问卷：硬皮病健康评估问卷（SHAQ）和迪鲁兹手部指数（DHI）。使用针对年龄和性别进行调整的逻辑回归来检验ES与潜在预测因素（教育水平、疾病特征、工作条件、SHAQ和DHI）之间的关联。纳入了91例患者（平均±标准差年龄53.7±11.8岁，22例有弥漫性皮肤受累，56例有指端溃疡（DU）病史）。只有22例患者仍在就业，而69例已退休，其中38例因SSc退休。在就业者中，9例从事体力劳动，9例长时间站立，3例必须在寒冷环境中工作。当分别对潜在预测因素进行检验并根据年龄和性别进行调整时，受过高等教育的患者（比值比（95%置信区间）11.36（2.03 - 63.36），P = 0.006）和无指端溃疡病史的患者就业几率更高。关节挛缩的存在以及工作需要举重与失业相关。在多变量模型中，高等教育（比值比5.91，95%置信区间0.97 - 36.09，P = 0.054）和较年轻的年龄（比值比0.90，95%置信区间0.85 - 0.96，P = 0.001）与继续就业独立相关。高中教育未显示出显著影响（比值比0.089，95%置信区间0.015 - 0.530，P = 0.008）。与无指端溃疡病史的患者相比，有指端溃疡病史的患者就业率最低。未发现就业状况与SHAQ或DHI评分之间存在显著关联。SSc与严重的工作残疾和提前退休相关。高等教育、无指端溃疡病史和较年轻的年龄与继续就业高度相关。鉴于SSc的罕见性，我们认为我们良好的样本量（n = 91）反映了疾病患病率，但结果应在其他研究中进行检验，并且在解释可推广性时应考虑单中心因素。
