Correlates and responsiveness to change of measures of skin and musculoskeletal disease in early diffuse systemic sclerosis

Arthritis Care Res (Hoboken). 2014 Nov;66(11):1731-9. doi: 10.1002/acr.22339.


Objective: Skin and musculoskeletal involvement are frequently present early in diffuse cutaneous systemic sclerosis (dcSSc). The current study examined the correlates for skin and musculoskeletal measures in a 1-year longitudinal observational study.

Methods: Patients with dcSSc were recruited at 4 US centers and enrolled in a 1-year study. Prespecified and standardized measures included physician and patient assessments of skin involvement, modified Rodnan skin score (MRSS), durometer score, Health Assessment Questionnaire disability index, serum creatine phosphokinase, tender joint counts, and presence/absence of tendon friction rubs, small joint contractures, and large joint contractures. Additionally, physician and patient global health assessments and health-related quality of life assessments were recorded. Correlations were computed among the baseline global assessments, skin variables, and musculoskeletal variables. Using the followup physician and patient anchors, effect sizes were calculated.

Results: A total of 200 patients were studied: 75% were women, mean ± SD age was 50.0 ± 11.9 years, and mean ± SD disease duration from first non-Raynaud's phenomenon symptom was 1.6 ± 1.4 years. Physician global health assessment had large correlations with MRSS (r = 0.60) and physician-reported skin involvement visual analog scale in the last month (r = 0.74), whereas patient global assessment had large correlations with MRSS, the Short Form 36 health survey physical component scale, skin interference, and skin involvement in the last month (r = 0.37-0.72). Four of 9 skin variables had moderate to large effect sizes (0.51-1.09).

Conclusion: Physician and patient global assessments have larger correlations with skin measures compared to musculoskeletal measures. From a clinical trial perspective, skin variables were more responsive to change than musculoskeletal variables over a 1-year period, although both provide complementary information.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Creatine Kinase / blood
  • Disability Evaluation
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Joints / physiopathology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / etiology*
  • Musculoskeletal Diseases / physiopathology*
  • Outcome Assessment, Health Care / methods*
  • Quality of Life
  • Scleroderma, Diffuse / complications*
  • Scleroderma, Diffuse / physiopathology*
  • Skin / physiopathology
  • Skin Diseases / etiology*
  • Skin Diseases / physiopathology*
  • Surveys and Questionnaires
  • Tendons / physiopathology
  • Visual Analog Scale


  • Creatine Kinase