{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T07:58:51Z","timestamp":1785484731657,"version":"3.56.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":201,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Weill Cornell Medicine Clinical and Translational Science Centre","award":["UL1 TR002384"],"award-info":[{"award-number":["UL1 TR002384"]}]},{"name":"Weill Cornell Medicine Clinical and Translational Science Centre","award":["NIH\/NIAMS K23 AR083509"],"award-info":[{"award-number":["NIH\/NIAMS K23 AR083509"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate contemporary global treatment of diffuse cutaneous systemic sclerosis (dcSSc) skin by SSc specialists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymous survey was distributed via the Scleroderma Clinical Trials Consortium, European Scleroderma Trials and Research Group (EUSTAR), and Collaborative National Quality and Efficacy Registry (CONQUER) distribution lists between June and September 2025. The survey comprised four sections: Demographics, Treatment of dcSSc Skin, Impact of Recent Guidelines, and Clinical Trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Responses included 103 physicians (93 completed): 43% North America, 31% Europe, 15% South America and 12% elsewhere. The majority practice within an SSc centre (80%) and participate in clinical trials (84%). Mycophenolate mofetil (MMF) was preferred first-line treatment (71%) for dcSSc without ILD, rising to 92% for dcSSc with mild\/non-progressive ILD. For active skin involvement despite MMF, trial referral was preferred as next step irrespective of ILD (59% without ILD and 58% with ILD). Treatment preferences have evolved, with 40% increasing MMF use and 47% decreasing methotrexate use, over the previous 2\u20133\u2009years. Biologic use has increased, with 56% and 37% reporting increasing rituximab and tocilizumab use, respectively. For dcSSc without ILD, 85% have prescribed rituximab, and 65% have prescribed tocilizumab. Biologic availability has impacted trial enrolment (73% agreement). Treatment decision-making for dcSSc skin involvement has been materially influenced by recent BSR and\/or EULAR guidelines (43% agreement).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MMF is preferred first-line for dcSSc. In the absence of compelling scientific justification for combination or step-up immunomodulatory approaches, trial referral is currently the preferred next treatment option. Biologic use is increasing, which impacts trial enrolment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/rap\/rkag086","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:18:12Z","timestamp":1784546292000},"source":"Crossref","is-referenced-by-count":0,"title":["Treating skin involvement in diffuse cutaneous systemic sclerosis: results from an international scleroderma specialist survey"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9343-5545","authenticated-orcid":false,"given":"Kimberly S","family":"Lakin","sequence":"first","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]},{"name":"Department of Medicine, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3357-9402","authenticated-orcid":false,"given":"Antonia","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"Department of Medicine, Pontificia Universidad Cat\u00f3lica de Chile , Santiago,","place":["Chile"]},{"name":"UC CHRISTUS Healthcare System Department of Clinical Immunology and Rheumatology, , Santiago,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2793-2364","authenticated-orcid":false,"given":"John D","family":"Pauling","sequence":"additional","affiliation":[{"name":"Department of Medicine, North Bristol NHS Trust , Bristol,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1091-379X","authenticated-orcid":false,"given":"Deanna P","family":"Jannat-Khah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]},{"name":"Department of Medicine, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0819-1990","authenticated-orcid":false,"given":"Kelsey","family":"Gripp","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2861-9466","authenticated-orcid":false,"given":"Oshmita","family":"Golam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-0922","authenticated-orcid":false,"given":"Robyn T","family":"Domsic","sequence":"additional","affiliation":[{"name":"Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Pittsburgh , Pittsburgh, PA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-6800","authenticated-orcid":false,"given":"Robert F","family":"Spiera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]},{"name":"Department of Medicine, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-0592","authenticated-orcid":false,"given":"Jessica K","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital for Special Surgery , New York, NY,","place":["USA"]},{"name":"Department of Medicine, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"2026073103163217700_rkag086-B1","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1136\/annrheumdis-2017-211448","article-title":"Mapping and predicting mortality from systemic sclerosis","volume":"76","author":"Elhai","year":"2017","journal-title":"Ann Rheum Dis"},{"key":"2026073103163217700_rkag086-B2","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1136\/ard.2006.066068","article-title":"Changes in causes of death in systemic sclerosis, 1972-2002","volume":"66","author":"Steen","year":"2007","journal-title":"Ann Rheum Dis"},{"key":"2026073103163217700_rkag086-B3","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/s41584-022-00765-9","article-title":"Skin involvement in early diffuse cutaneous systemic sclerosis: an unmet clinical need","volume":"18","author":"Herrick","year":"2022","journal-title":"Nat Rev Rheumatol"},{"key":"2026073103163217700_rkag086-B4","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.semarthrit.2012.01.003","article-title":"(SCTC) pmotSCTC, (CSRG) CSRG. Treatment of systemic sclerosis complications: what to use when first-line treatment fails\u2014a consensus of systemic sclerosis experts","volume":"42","author":"Walker","year":"2012","journal-title":"Semin Arthritis Rheum"},{"key":"2026073103163217700_rkag086-B5","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1002\/art.40560","article-title":"Treatment algorithms for systemic sclerosis according to experts","volume":"70","author":"Fern\u00e1ndez-Codina","year":"2018","journal-title":"Arthritis Rheumatol"},{"key":"2026073103163217700_rkag086-B6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1136\/annrheumdis-2016-209909","article-title":"Update of EULAR recommendations for the treatment of systemic sclerosis","volume":"76","author":"Kowal-Bielecka","year":"2017","journal-title":"Ann Rheum Dis"},{"key":"2026073103163217700_rkag086-B7","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1002\/acr.23282","article-title":"Efficacy of mycophenolate mofetil and oral cyclophosphamide on skin thickness: post hoc analyses from two randomized placebo-controlled trials","volume":"70","author":"Namas","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026073103163217700_rkag086-B8","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1016\/S2665-9913(21)00107-7","article-title":"Safety and efficacy of rituximab in systemic sclerosis (DESIRES): a double-blind, investigator-initiated, randomised, placebo-controlled trial","volume":"3","author":"Ebata","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2026073103163217700_rkag086-B9","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1093\/rheumatology\/keaa550","article-title":"Rituximab in the treatment of systemic sclerosis-related interstitial lung disease: a systematic review and meta-analysis","volume":"60","author":"Goswami","year":"2021","journal-title":"Rheumatology (Oxford)"},{"key":"2026073103163217700_rkag086-B10","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/S2213-2600(20)30318-0","article-title":"Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"8","author":"Khanna","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2026073103163217700_rkag086-B11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/ard-2024-226430","article-title":"EULAR recommendations for the treatment of systemic sclerosis: 2023 update","volume":"84","author":"Del Galdo","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026073103163217700_rkag086-B12","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1093\/rheumatology\/keae394","article-title":"The 2024 British Society for Rheumatology guideline for management of systemic sclerosis","volume":"63","author":"Denton","year":"2024","journal-title":"Rheumatology (Oxford)"},{"key":"2026073103163217700_rkag086-B13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/2397198318783926","article-title":"An interim report of the scleroderma clinical trials consortium working groups","volume":"4","author":"Baron","year":"2019","journal-title":"J Scleroderma Relat Disord"},{"key":"2026073103163217700_rkag086-B14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1136\/annrheumdis-2013-203997","article-title":"Ten years EULAR Scleroderma Research and Trials (EUSTAR): what has been achieved?","volume":"73","author":"M\u00fcller-Ladner","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"2026073103163217700_rkag086-B15","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s10067-019-04792-y","article-title":"Collaborative National Quality and Efficacy Registry (CONQUER) for Scleroderma: outcomes from a multicenter US-based systemic sclerosis registry","volume":"39","author":"Shanmugam","year":"2020","journal-title":"Clin Rheumatol"},{"key":"2026073103163217700_rkag086-B16","doi-asserted-by":"crossref","first-page":"e70004","DOI":"10.1002\/acr2.70004","article-title":"Comparative efficacy of immunosuppressive therapies in the treatment of diffuse cutaneous systemic sclerosis","volume":"7","author":"White","year":"2025","journal-title":"ACR Open Rheumatol"},{"key":"2026073103163217700_rkag086-B17","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1177\/23971983251328797","article-title":"Evaluation and prescription trends in systemic sclerosis: report of a survey among Indian rheumatologists","volume":"10","author":"Das","year":"2025","journal-title":"J Scleroderma Relat Disord"},{"key":"2026073103163217700_rkag086-B18","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1002\/art.42850","article-title":"Outcomes of patients with diffuse systemic sclerosis eligible for autologous stem cell transplantation treated with conventional therapy","volume":"76","author":"Gregory","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"2026073103163217700_rkag086-B19","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1002\/1529-0131(199809)41:9<1613::AID-ART11>3.0.CO;2-O","article-title":"Case-control study of corticosteroids and other drugs that either precipitate or protect from the development of scleroderma renal crisis","volume":"41","author":"Steen","year":"1998","journal-title":"Arthritis Rheum"},{"key":"2026073103163217700_rkag086-B20","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s00296-010-1697-6","article-title":"Corticosteroids and the risk of scleroderma renal crisis: a systematic review","volume":"32","author":"Trang","year":"2012","journal-title":"Rheumatol Int"},{"key":"2026073103163217700_rkag086-B21","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s12016-022-08945-x","article-title":"Renal disease and systemic sclerosis: an update on scleroderma renal crisis","volume":"64","author":"Cole","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026073103163217700_rkag086-B22","doi-asserted-by":"crossref","first-page":"5354","DOI":"10.1093\/rheumatology\/keaf290","article-title":"Temporal trends in vascular medication use in 8079 patients with systemic sclerosis: insights to inform future trials and therapeutic strategies from the EUSTAR cohort","volume":"64","author":"Di Donato","year":"2025","journal-title":"Rheumatology (Oxford)"},{"key":"2026073103163217700_rkag086-B23","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1093\/rheumatology\/kez417","article-title":"How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality?","volume":"59","author":"Spierings","year":"2020","journal-title":"Rheumatology (Oxford)"}],"container-title":["Rheumatology Advances in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rheumap\/advance-article-pdf\/doi\/10.1093\/rap\/rkag086\/69682718\/rkag086.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/10\/3\/rkag086\/69682718\/rkag086.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/10\/3\/rkag086\/69682718\/rkag086.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T07:16:39Z","timestamp":1785482199000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rheumap\/article\/doi\/10.1093\/rap\/rkag086\/8739090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6,15]]}},"URL":"https:\/\/doi.org\/10.1093\/rap\/rkag086","relation":{},"ISSN":["2514-1775"],"issn-type":[{"value":"2514-1775","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2026]]},"article-number":"rkag086"}}