POS0854 HOPELESSNESS LEVELS ARE SIGNIFICANTLY INCREASED IN SYSTEMIC SCLEROSIS PATIENTS AND CORRELATE WITH THE RAYNAUD CONDITION SCORE AND DIGITAL ULCER SEVERITY
Authors: P. Bearzi, M. Minerba, C. Salvolini, L. Quarta, G. Lanaia, D. Currado, A. Marino, E. Corberi, T. Cocchiaro, M. Vizzini, M. Vomero, O. Berardicurti, A. Marcoccia, L. Navarini, R. Giacomelli
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic sclerosis (SSc) is a multiorgan autoimmune fibrotic disease, determining a significant burden on patients' psycho-social life. In the field of major depressive disorders, hopelessness is a defining subjective emotion characterized by a bleak pessimistic view of the future and the idea that "nothing good is going to happen to me". To this regard, a previous study showed the inefficacy of mindfulness-based strategy in decreasing hopelessness levels in SSc. Hopelessness is associated with therapeutic compliance, suicidal risk and chronic pain, as observed in different chronic diseases (including rheumatoid arthritis and systemic lupus erythematosus). <h3>Objectives:</h3> To measure the hopelessness levels, according to the validated Beck Hopelessness Scale(BHS), in SSc patients and identify the possible correlation between hopelessness and clinical parameters. <h3>Methods:</h3> 76 (97% female) patients responding to ACR/EULAR 2013 SSc classification criteria and 32 healthy controls, matched per age and sex, were recruited. SSc patients were evaluated at each timepoint (0, 2, 4 and 6 months) for: presence/severity of digital ulcers (DUCAS and DUVAS), Patient Global Assessment (PtGA), Raynaud Condition Score (RCS), HAMIS scale, BHS, Hospital Anxiety and Depression Scale (HADS), Facit Fatigue Scale e Body Image Scale (BIS), Short Form Health Survey 36 (SF-36). At baseline and 6 months evaluation for disease severity (mRSS, Medgser Severity Scale-MSS and presence of ILD, history of DU), was performed. Mann-Whitney test has been applied for statistical differences for continuous variables, while Chi-square test has been used for contingency tables. We performed a linear mixed model to assess the association between BHS and demographic, clinical, and psychometric variables. Statistical significance was p&lt;0.05. Statistics have been performed on Stata v.10 (College Station, Texas, USA). <h3>Results:</h3> BHS was significantly higher in SSc patients vs control (p&lt;0.0001). In SSc patients, all SF-36 domains were significantly decreased and FACIT fatigue and HADS were significantly increased, compared to healthy controls (Table 1). Dividing the population according to the cut-off of BHS = 8, marking the difference between minimal/mild and severe hopelessness at baseline (Table 2), higher BHS levels were associated with higher RCS (p=0.0018), HAMIS scale (p=0.0271), HADS (p&lt;0.0001), BIS (p&lt;0.0001), FACIT fatigue (p&lt;0.0001) and lower SF-36 PCS (p=0.0117) and MCS (p&lt;0.0001). Performing a mixed linear model, corrected for age and sex, on the total SSc population the dependent variable BHS was related to RCS (CI 95% [0.0028 - 0.2516]; p= 0.045) and PtGA (CI 95% [0.0071 - 0.2463], p= 0.038). Furthermore, in patients with digital ulcers during follow-up, a mixed linear model corrected for age and sex showed that BHS was related to DUCAS (CI95% [0.1474 - 1.2680], p=0.013) and RCS (CI95% [0.0392 - 0.6594], p =0.027). <h3>Conclusion:</h3> Hopelessness was significantly higher in SSc patients compared to healthy controls. BHS score showed significant association with increased Raynaud's severity (RCS) and decreased hand functionality, assessed by HAMIS scale. Furthermore, RCS is independently associated with hopelessness levels in SSc patients, suggesting the crucial impact of Raynaud's phenomenon on this domain. In patients with digital ulcers, DUCAS score is independently related to the BHS score, thus suggesting that digital ulcers are a major cause of hopelessness in SSc patients. In conclusion, better control of Raynaud's phenomenon and efficacious treatment of digital ulcers might affect hopelessness levels in SSc patients, thus increasing therapeutic compliance and psychosocial well-being.<b>REFERENCES: NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>