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Introduction Systemic sclerosis (SSc) is a multisystemic disease that significantly impacts quality of life and function. The SSc-specific Scleroderma Health Assessment Questionnaire (SHAQ) measures functional disability and incorporates five visual analogue scales (VAS) assessing patient-reported impairment due to Raynaud’s phenomenon (RP), digital ulcers (DU), gastrointestinal (GI) symptoms, respiratory symptoms, and overall disease severity. We aim to evaluate the relationship between SHAQ and objective disease measures and identify potential factors associated with disability in SSc.Material and Methods A retrospective observational study of adult SSc patients from our center was conducted. Continuous variables are reported as mean±SD, and categorical variables as frequencies. Comparisons used chi-squared and Mann-Whitney U tests. Correlations used Spearman’s coefficient. Factors possibly associated with SHAQ were analysed using separate multiple linear regression models. Significance was set at p<0.05.Results We included 106 patients, 96(90.6%) were female. Mean age was 59.1±12.5years and disease duration 11.1±10.7years. Limited cutaneous SSc was the most common SSc form (73.6%). RP occurred in 98.1% and DU in 34%. Pulmonary involvement was present in 18.9%, GI in 35.8%, articular in 38.5%, and cardiac in 1.9%.Mean SHAQ was 1.6±0.8: 21.7% of patients reporting mild (SHAQ<1), 45.3% moderate (1<=SHAQ<2), and 33% severe (SHAQ>=2). SHAQ was higher in diffuse SSc [2.13±0.9;p=0,03], patients with pulmonary involvement [2.05±0.6;p=0.006], GI involvement [1.78±0.7;p=0.02], and those on bDMARD therapy [2.80±0.2; p=0.002]. A correlation was also found with Medsger disease severity scale: general [r=0.251; p=0.020] and joint/tendon [r=0.231;p=0.035] domain scores.Among the VAS domains, the highest values were reported for the overall disease severity VAS (52.5±26.6). Mean VAS impairment for RP was 25.6±32.4, for DU was 2.3±11.5 and, for GI symptoms was 20.1±29.6. VAS respiratory impairment was 19.8±29.4, patients with pulmonary involvement reported higher values [44±34;p<0.001] and presented correlation with Medsger’s pulmonary severity [r=0.241; p=0.029].In separate multivariable models, higher SHAQ scores were associated with modified Rodnan skin score [B=0.026; p=0.043], C-reactive protein (CRP)[B=0.028; p=0.029], presence of pulmonary involvement [B=0.563; p=0.005], use of csDMARD [B=0.366; p=0.018], and bDMARD [B=0.754; p=0.005].Conclusions SHAQ revealed a predominantly moderate functional impact, with overall disease severity and pulmonary symptoms emerging as the most burdensome domains. Higher SHAQ scores are significantly associated with skin and pulmonary involvement, CRP levels, and DMARD use, confirming its validity as a patient-reported measure of multisystem impact in SSc. These findings suggest that patients have a real perception of their disease severity, further supported by the association between SHAQ and pulmonary involvement, a major determinant of vital prognosis.