Dear Editor, We read with interest the well-designed systematic review (SR) published by Fischer et al.  assessing the humanistic and economic burden of Systemic Sclerosis (SSc). As reported in the review by Fisher et al., SSc is associated with a large humanistic and economic burden to individual patients and society. In their report, the main identified studies evaluated the estimated annual cost of different countries per SSc patient, showing the relevant cost of SSc on the total health care cost estimation. However, as stated by the authors, their study presented some limitations, the most important which was the study type, that was not a systematic review of the literature. Therefore, as the importance of the topic analysed in the study,we have some comments about somemissing points of their detailed analysis. In accordance with the results of Fischer et al. , Ingegnoli et al.  and Nguyen et al.  demonstrated that patients affected by SSc present several socio-economic burden consequences, as well as a global negative impact on the individual's well-being. However, for the evaluation of the humanistic burden of SSc, Ingegnoli et al.  and Nguyen et al.  included specific parameters in term of the evaluation of the impact on patient's quality of life and daily functioning, as the mouth handicap index. Both studies found that the mouth disability, validated asMouth Handicap In SSc (MHISS) scale questionnaire , is an important feature that negatively influences the employment status and socio-economic burden and, globally, the quality of life in SSc patients . The MHISS scale includes 12 items with five levels of answers, covering three relevant clinical aspects of SSc: limitations in activity related to reduced mouth opening, to sicca syndrome, and to aesthetic concerns. MHISS scale was found to possess an excellent reliability and good validity for the evaluation of the oral burden during SSc [4,5]. This scale has been developed in French and validated in French, Italian, and Dutch [4,6]. Vitali et al. created the SclerodermaLogopedic Scale (SLS) to assess the oropharyngeal area disorders in SSc patients . This 58-items scale is divided into five subscales (Impairment, Swallow, Voice, Multifield and Quality of life) but seems more difficult to use in the daily practice. Moreover, to achieve greater integration of research and practice, the European League Against Rheumatism (EULAR) endorsed an initiative to develop a repository of the main cross-culturally validated patient reported outcomes (PROs); the EULAR Outcome Measures Library (OML) . The OML is widely used as indices, questionnaires Autoimmunity Reviews 17 (2018) 323–324 or scales in rheumatic and musculoskeletal diseases. In the OML, MHISS was identified as one of the main important measures in the evaluation of PRO instruments for many rheumatic conditions . Systemic Sclerosis (SSc) is a systemic inflammatory disease characterized by symmetric, erosive synovitis, which may result in joint erosion and irregularity. As a synovial joint, the temporomandibular joint (TMJ) itwas shown to be usually involved during SSc,with a TMJs erosion correlated with a length and worsening of SSc . A wide variety of affections have been showed induced by the TMJs involvement and joint erosion in these patients, as reduced mouth opening and chewing disorder, all influencing theMHISS [10–11].Moreover,within the last few years, many evidence has demonstrated that the impairment induced by the TMJ and oral involvement determines a lower quality of life in SSc patients strongly sustained by the handicap of the orofacial disabilities during the active phase of the disease , emphasizing the need for quantifying the handicap related to mouth disability. In this regards, is our opinion that future studies or review, aimed to describes thehumanistic and cost burden of SSc, should also include the effects of the oral disabilities in the global burden of disease during SSc. This comprehensive approach could also stimulate further research aimed to provide interesting methods useful to open future directions for the treatment of the oral impairment in patients affected by SSc.
|Titolo:||Systemic Sclerosis: Small mouth, big burden?|
ISOLA, GAETANO [Writing – Review & Editing] (Corresponding)
|Data di pubblicazione:||2018|
|Appare nelle tipologie:||1.1 Articolo in rivista|