Background/Purpose:

Little research has evaluated body image dissatisfaction (BID) in Systemic Sclerosis (SSc). What has been conducted shows that BID is common and associated with worse psychosocial functioning. Additionally, age, upper-body telangiectasias, fingertip-to-palm distance, and facial skin involvement have been shown to be associated with Dissatisfaction with Appearance and Social Discomfort, two components of BID. However, it remains unclear if these factors relate to BID in the same way across disease classification (i.e., limited versus diffuse disease). Because limited and diffuse patients may have very different physical disease manifestations, the current study aimed to determine if sociodemographic and medical correlates of BID differed for patients with limited versus diffuse SSc, and identify which variables related to the two components of BID for each disease classification.

Methods:

Participants were adults participating in the UCLA Scleroderma Quality of Life Study with rheumatologist-diagnosed limited (n = 101) or diffuse (n = 82) SSc. The Brief-Satisfaction with Appearance Scale (Brief-SWAP), which is comprised of two subscales measuring Dissatisfaction with Appearance and Social Discomfort, evaluated BID. The present analysis 1) examined if the relationships of sociodemographic (i.e., age, gender, race, education, and marital status) and medical (i.e., disease duration, presence of telangiectasis, presence of hyper/hypo-pigmentation, and facial, hand/finger, forearm, and leg/foot skin involvement) variables to the Brief-SWAP subscales were equivalent for limited and diffuse SSc, and 2) identified which of these variables were associated with each of the two Brief-SWAP subscales. Structural Equation Modeling evaluated both of these research questions. Both statistical and practical indicators of model fit were considered. 

Results:

There were similarities and differences in how sociodemographic and medical variables related to BID for limited versus diffuse SSc (S-Bχ² [143] = 181.42, p = .02; RMSEA = .06, CFI = .91, SRMR = .06). Greater Dissatisfaction with Appearance was associated with younger age (b = -.02, SD = .01) and being unmarried (b = -.64, SE = .30) for limited patients, and with younger age (b = -.02, SE = .01) and increased finger/hand skin involvement  (b = .69, SE = .15) for diffuse patients (ps < .05). Greater Social Discomfort was associated with younger age (b = -.02, SE = .01) and being unmarried (b = -.46, SE = .22) for both subtypes (ps < .05). 

Conclusion:

Both sociodemographic (i.e., age, marital status) and medical (i.e., finger/hand skin involvement) variables were related to BID. This is consistent with prior research and underscores the complex nature of BID in SSc. The present analysis suggests that young, unmarried patients may be at greatest risk for BID across disease subtypes.  However, these factors may be more important for patients with limited disease, and finger/hand skin involvement may also be important for patients with diffuse disease. These findings can inform development of optimal, targeted interventions to diminish BID in SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlates-of-body-image-dissatisfaction-in-patients-with-limited-and-diffuse-systemic-sclerosis/