Background/Purpose: Systemic sclerosis (SSc) is a severe autoimmune connective-tissue disease characterized by vasculopathy, immune activation, and subsequent fibrosis of skin, lungs, heart, kidney or gastrointestinal tract, with a poor prognosis. SSc burden on both quality of life and neuropsychological functions is well recognized.

Chronic and life-threatening illnesses are major stress factors, recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders-IV as being at risk of triggering posttraumatic stress disorder (PTSD).

The particularity of traumatic events in chronic illnesses is that they can be multiple, persistent over time and repeated. A number of situations have been identified as traumatic by patients, notably the diagnosis announcement. If left untreated, PTSD in chronic illnesses can lead to severe and prolonged symptoms, with psychiatric and addictive comorbidities, chronic pain, asthenia, impaired quality of life and immune function, poorer compliance with treatment, increased need for care and higher overall morbidity and mortality. To the best of our knowledge PTSD has never been studied in SSc.

The objectives of our study were to determine the incidence of PTSD secondary to the diagnosis announcement of SSc and its determinants.

Methods: We prospectively included all consecutive SSc adult (≥18 years) patients from the Systemic Scleroderma Toulouse Cohort who came for their annual check-up at Toulouse University Hospital from 10/01/2017 to 12/31/2021. PTSD was defined by the Posttraumatic Stress Disorder Checklist for DSM-V  with a threshold score ≥ 32.

 We compared SSc-patients characteristics’ with and without PTSD.

Univariable and multivariable logistic regression models were used to determine baseline variables associated with PTSD.

Results: One hundred and eleven patients were included, 28 (25%) with diffuse cutaneous SSc, 86 (78%) were female with a median age of 62 [IQR 1-3: 53-68] years and a median follow-up of 9 [5-15] years. Thirty three (31%) had an interstitial lung disease, 12 (11%) a cardiac involvement,  and 3 (3%) pulmonary arterial hypertension (PAH). Fifty (45%) SSc patients were on immunosuppressants, 13 (12%) had an autologous hematopoietic stem cells transplantation and one a heart transplant. Fifteen (14%) SSc patient of our cohort had PTSD. Factors associated with PTSD were PAH (OR 0.08; p=0.05), greater impairment of sHAQ (OR 0.22; p=0.01)  , greater peri-traumatic distress and dissociation  (OR 0.04; p=0.01)  and more anxiety-depressive disorders (OR 0.14; p=0.02).

Conclusion: Even after a median follow-up of 9 [5-15] years 14% SSc patient of our cohort still had PTSD, significantly associated with anxiety-depressive disorders and, peri-traumatic distress and peri-traumatic dissociation, which are two important peri-traumatic risk factors for PTSD. Screening for and management of PTSD following the announcement of SSc by a multidisciplinary team could help improve quality of life, psychiatric comorbidities, pain and asthenia, as well as promoting the management of SSc by improving patients’ adherence to their care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-of-posttraumatic-stress-disorder-secondary-to-the-diagnosis-of-systemic-sclerosis/