title: Impact of systemic sclerosis on occupational and professional activity with attention to patients with digital ulcers.
abstract: OBJECTIVE
  To evaluate the impact of systemic sclerosis (SSc; scleroderma) and digital ulcers (DUs) on daily living and professional activities.
  
  
  METHODS
  We prospectively evaluated 189 SSc patients for employment status and disability during meetings of the French SSc patient association (n=86, 45.5%) or during hospitalization (n=103, 54.5%).
  
  
  RESULTS
  Seventy-eight (41.2%) patients had diffuse SSc. The mean±SD age was 54±13 years, and the mean±SD disease duration was 9.3±8.4 years at the time of evaluation. Sixty (31.7%) patients had at least one DU. Assessed using the Health Assessment Questionnaire (mean±SD 1.12±0.79 versus 1.39±0.84; P=0.001), the Cochin Hand Function Scale (mean±SD 20.2±18.3 versus 27.8±19.1; P<0.0001), and the Hospital Anxiety Scale (mean±SD 9.9±5 versus 8.5±4.2; P=0.04), global disability, hand disability, and anxiety, respectively, were significantly higher in patients with DUs than in others. Most patients reported a limitation in daily activities related to SSc, as assessed by a daily activity limitation scale (mean±SD 4.4±2.9) and an increased need for help in the home. Patients reported needing mean±SD 4±13.5 hours per month of paid household help related to SSc and mean±SD 1.5±10 hours per month related to DUs, with significant differences between patients with or without DUs (P=0.004). Among the 113 patients in the workforce, 67 (59.3%) were employed, 42 (37.2%) were employed full time, 36 (31.8%) received full disability pension, and 27 (23.9%) were on sick leave, with no difference between patients with or without DUs.
  
  
  CONCLUSIONS
  SSc has a significant impact on activities of daily living and work disability. The need for external home help and disability are increased for those patients with DUs.
authors.affiliation: Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Department of Internal Medicine, Cochin Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Bérezné
authors.forename: R
authors.initials: R
authors.lastname: Seror
authors.forename: S
authors.initials: S
authors.lastname: Morell-Dubois
authors.forename: M
authors.initials: M
authors.lastname: de Menthon
authors.forename: E
authors.initials: E
authors.lastname: Fois
authors.forename: A
authors.initials: A
authors.lastname: Dzeing-Ella
authors.forename: C
authors.initials: C
authors.lastname: Nguyen
authors.forename: E
authors.initials: E
authors.lastname: Hachulla
authors.forename: L
authors.initials: L
authors.lastname: Guillevin
authors.forename: S
authors.initials: S
authors.lastname: Poiraudeau
authors.forename: L
authors.initials: L
authors.lastname: Mouthon
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D005385:Fingers; D006801:Humans; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications*; D012883:Skin Ulcer