The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Pain Perspective in Scleroderma

Pain Perspective in Scleroderma

July 12, 2011 • By Susan L. Williams Judge, MN, ARNP

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Pain Perspective in Scleroderma

Systemic sclerosis (SSc; scleroderma) is a disease in which inflammatory and fibrotic changes result in overproduction and accumulation of collagen and other extracellular matrix proteins, resulting in intimal vascular damage, fibrosis, and occasionally organ dysfunction affecting the gastrointestinal, lung, heart, and renal systems. There are two classifications of SSc—limited cutaneous or CREST (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangectasias) syndrome, where skin thickening occurs mainly in the distal extremities and facial/neck areas and internal organ involvement, if present, occurs later in the disease process; and diffuse cutaneous disease where there is a more rapid progression of skin thickening from distal to proximal and organ involvement can be severe and occur early in the disease.1,2 As noted by various authors, there is no “crystal ball” into which one can look to see the outcome of the disease, and involvement varies significantly from one person to the next.

You Might Also Like
  • Studies Show Promise for Scleroderma Therapy and Prediction of Progressing Disease
  • Living Well with Scleroderma
  • Targeted Therapy for Scleroderma Fibrosis
Explore This Issue
July 2011

The role of the nurse practitioner/physician assistant is integral in assessing the various components of disability and pain experienced by the scleroderma patient. We work closely with various disciplines, including occupational and physical therapists, who can add greatly to the everyday functioning of our patients who need braces, splints, adaptive equipment, and rehabilitation therapy to pursue cherished activities when claw deformities, skin tethering, and breathing difficulties or other organ involvement interferes with activities of daily living. Pain takes many forms with our scleroderma patients. Arthralgias and muscle tenderness, difficulty with swallowing, constipation resulting in “rabbit pellet” stools, and air hunger or subjective feelings of shortness of breath can lead to depression and disability. Medications can ease symptoms and promote quality of life, and a complete review of systems, including functional assessment, should be an integral part of every clinic visit, with therapies geared toward promoting optimal health and decreasing disability.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

How exactly do we assess disability in this complex and variably presenting disease? As Sultan et al have lamented, no one to date has adequately defined the concept of disability in scleroderma, particularly across cultural lines.3 Is it the functional component or the disability component that should lend weight to our formal assessments? Several measurement tools have been identified for use in clinical trials. The Hand Mobility in Scleroderma Test (HAMIS), the United Kingdom Scleroderma Functional Score, and the Rodnan skin scoring system have been used extensively.3,4 Ultrasound is an emerging imaging technique that is readily available and noninvasive, allowing for the evaluation of dermal thickening and echogenicity.5 One tool that is validated and used extensively in the rheumatoid and osteoarthritis populations is the Health Assessment Questionnaire Disease Index (HAQ-DI), a measurement of disability evaluating eight domains of activity. A hybrid of the HAQ-DI, the Scleroderma Health Assessment Questionnaire (SHAQ), first used by Steen and Medsger, adds five scleroderma-specific visual analog scales to evaluate how Raynaud’s phenomenon, digital ulcerations, breathing, and intestinal problems as well as disease activity impact the individual patient.6 This tool has been evaluated for different construct validities, is fairly easy to use in the office as well as in clinical trials, and can be used to evaluate overall patient functioning, thus streamlining the patient visit.6

Pages: 1 2 | Single Page

Filed Under: Conditions, From the College, Scleroderma Tagged With: Diagnostic Criteria, disability, Pain, patient care, Scleroderma, Systemic sclerosisIssue: July 2011

You Might Also Like:
  • Studies Show Promise for Scleroderma Therapy and Prediction of Progressing Disease
  • Living Well with Scleroderma
  • Targeted Therapy for Scleroderma Fibrosis
  • Stem Cell Transplantation Benefits Patients with Scleroderma

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.