Longitudinal analysis of quality of life in patients with undifferentiated connective tissue diseases

Abstract

Introduction/objectivesTo prospectively assess the quality of life (QoL) of patients affected by undifferentiated connective tissue diseases (UCTDs) and to identify factors associated with changes over time.Patients and methodsA total of 46 consecutive UCTD patients completed the Short-Form 36 (SF-36) questionnaire at presentation and then yearly. At each 6-month visit, all patients underwent a detailed history taking and a laboratory and physical assessment, in order to follow the evolution of the disease over time and to assess the the co-existence of fibromyalgia.ResultsAt presentation, scores lower than the average of the general population were detected in 34 (74%) and 41 (89%) patients in the physical and mental domains, respectively. No difference between patients with and without Raynaud’s phenomenon was detected. Fibromyalgia was the only independent variable associated with an impaired physical component summary score (p = 0.0009). No patient feature was found to be associated with the basal mental component summary score. During 24 months of follow-up, a significant improvement (ie, a change ≥5 from baseline) in physical component summary and mental component summary scores was observed in 14 (33.3%) and 20 (43.4%) patients, respectively. Patients who significantly improved in the physical domain more frequently had a history of glucocorticoids intake (p<0.001), while those who improved in the mental component more frequently had a history of either glucocorticoids (p = 0.043) or immunosuppressors (p = 0.037) intake during follow-up.ConclusionUCTD patients perceive a worse QoL, regardless of Raynaud’s phenomenon Fibromyalgia is one of the major contributors of physical QoL, whereas no factor influencing mental component has been identified. An improvement in QoL can be observed in less than half of patients over a 2-year follow-up. Larger studies are needed to identify factors influencing QoL and to define the role of pharmacological treatments.

“Mixed connective tissue disease”: a condition in search of an identity

“…Oesophageal hypomobility is rarely reported [38], and sometimes, only dysphagia is mentioned [39], with a range from 1 to 7.2%. Iudici et al addressed the quality of life in 46 patients with UARD (follow-up 7.5 ± 5.5 years), among whom, gastrointestinal symptoms (dyaphagia/heartburn and early satiety) were reported in 32,6% [40].…”

Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study

“…Rheumatoid conditions are often accompanied by fibromyalgia, which may be added as a diagnostic label for the resultant diffuse pain. 49 In contrast to women, men with fibromyalgia were more likely to have several general medical conditions, including myocardial infarction, peripheral vascular disease, cerebrovascular accidents, and diabetic complications, including pain. It could be speculated that the greater age of men might explain this discrepancy, and while this was partially true, these differences persisted after adjustment for age in multiple logistic regression.…”

The Psychosocial Impact of Undifferentiated Connective Tissue Disease on Patient Health and Well-Being

“…Although a few clinical variables have been associated with evolution of UCTD, 34 it remains difficult to predict a given patient's trajectory. In a longitudinal Italian cohort of 46 patients, UCTD was associated with impaired quality of life across physical and mental domains; fibromyalgia contributed to worsened physical quality of life, whereas factors influencing the mental component were not identified 18 . Although various treatments have been proposed to delay onset of defined CTD, 35–39 there are no evidence-based guidelines for management of UCTD 40 .…”

“…Undifferentiated connective tissue disease patients have impaired health-related quality of life, related to both physical and mental health, although the reasons for this are unknown. 17,18 The objective of this qualitative study is to explore patients' perceptions and illness experiences to understand the psychosocial impact of UCTD and guide clinical interventions.…”