Clinical and psychosocial determinants of oral handicap in systemic sclerosis: a cross-sectional study

To examine the relationship between oral handicap, clinical characteristics, psychosocial status, and quality of life in patients with systemic sclerosis (SSc). This cross-sectional study included 99 patients with SSc. Oral handicap was assessed using the Mouth Handicap in Systemic Sclerosis Scale (MHISS). Social appearance anxiety, anxiety/depression symptoms, resilience, and quality of life were evaluated using the Social Appearance Anxiety Scale, Hospital Anxiety and Depression Scale, Brief Resilience Scale, and World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. Statistical and hierarchical multiple regression analyses were also performed. Oral handicap was associated with female sex (rho = 0.220, p = 0.029) and diffuse cutaneous SSc subtype (rho =  - 0.482, p < 0.001). Oral handicap showed strong positive correlations with the facial and total modified Rodnan Skin Score (rho = 0.851 and rho = 0.737; both p < 0.001). Positive associations were also observed for gastrointestinal (GI) involvement, calcinosis, telangiectasia, Scl-70 positivity, and digital ulcers (p < 0.002 for all). MHISS scores were positively correlated with anxiety, depression, and social appearance anxiety, and negatively correlated with all WHOQOL-BREF domains (p < 0.001 for all). In the regression analyses, mRSS (β = 0.484, p < 0.001), GI involvement (β = 0.210, p = 0.006), and anxiety scores (β = 0.183, p = 0.036) remained independently associated with oral impairment. The clinical model explained an additional 54% of variance, with a further 5% contributed by psychosocial variables. Oral impairment in SSc reflects both clinical disease burden and psychosocial distress, underscoring its multifactorial nature.