{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:48:37Z","timestamp":1789663717729,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009096","name":"Firat \u00dcniversitesi","doi-asserted-by":"publisher","award":["TF.25.62"],"award-info":[{"award-number":["TF.25.62"]}],"id":[{"id":"10.13039\/100009096","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hum Biol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Systemic sclerosis (SSc) demonstrates marked female predominance, suggesting hormonal influences in disease pathogenesis. The second\u2010to\u2010fourth digit ratio (2D:4D), a biomarker of prenatal androgen exposure, has been associated with various autoimmune conditions. This study investigated whether 2D:4D ratios differ between female SSc patients and healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This case\u2013control study enrolled 33 women with SSc (2013 ACR\/EULAR criteria) and 30 age\u2010matched healthy female controls. Second and fourth digit lengths were measured bilaterally using digital calipers, and 2D:4D ratios were calculated. Between\u2010group differences were analyzed using Welch's t\u2010test and Mann\u2013Whitney U test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SSc patients demonstrated significantly lower 2D:4D ratios than controls bilaterally (right hand: 0.950\u2009\u00b1\u20090.029 vs. 1.022\u2009\u00b1\u20090.012,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; left hand: 0.951\u2009\u00b1\u20090.030 vs. 1.022\u2009\u00b1\u20090.012,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Effect sizes were substantial (Cohen's d\u2009&gt;\u20092.8). The lower ratios resulted from longer fourth digits rather than shorter second digits, consistent with elevated prenatal androgen exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Female SSc patients exhibit significantly lower 2D:4D ratios than healthy controls, suggesting higher prenatal testosterone exposure. These findings support the hypothesis that the prenatal hormonal environment may contribute to autoimmune disease susceptibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajhb.70224","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:55:03Z","timestamp":1771052103000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Second to Fourth Digit Ratio (\n                    <scp>2D<\/scp>\n                    :\n                    <scp>4D<\/scp>\n                    ) in Female Patients With Systemic Sclerosis: Evidence for Prenatal Androgen Exposure"],"prefix":"10.1002","volume":"38","author":[{"given":"Ramazan Fazil","family":"Akkoc","sequence":"first","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine Firat University  Elazig Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6725-4182","authenticated-orcid":false,"given":"Ahmet","family":"Karatas","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Faculty of Medicine Firat University  Elazig Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Oz","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Faculty of Medicine Firat University  Elazig 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