{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T01:51:43Z","timestamp":1769910703086,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education, Science, and Technological Development of the Republic of Serbia","award":["451-03-66\/2024-03\/200110"],"award-info":[{"award-number":["451-03-66\/2024-03\/200110"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The European League Against Rheumatism (EULAR), in collaboration with the European Scleroderma Trial and Research group (EUSTAR), published the first set of treatment recommendations for systemic sclerosis (SSc) in 2009, with subsequent updates in 2016 and 2023. Objectives: This study aimed to evaluate how rheumatologists\u2019 clinical approaches to the treatment of SSc evolved following the 2016 update of the clinical management guidelines. Methods: Medication use for SSc was analyzed in a cohort of 378 patients. The patients were stratified based on enrollment before (233 patients) and after (145 patients) the guideline update, and medication usage was compared between the two groups. Results: Although all patients presented with Raynaud\u2019s phenomenon (RP), only 35% received calcium channel blockers. Medications such as iloprost, phosphodiesterase type 5 (PDE-5) inhibitors, fluoxetine, and bosentan, recommended for the treatment of RP and digital ulcers, were not approved for SSc by the Republic Health Insurance Fund. Treatment for pulmonary arterial hypertension (PAH) was administered to only 16 patients (4.2%), including 2 who received bosentan, 10 who received PDE-5 inhibitors, and 4 who were treated with riociguat. The use of PDE-5 inhibitors increased following the 2016 update of the guidelines. Cyclophosphamide was consistently prescribed for interstitial lung disease (ILD), with an increased frequency observed after the guideline update. No significant differences were observed in the use of methotrexate for skin involvement, ACE inhibitors for scleroderma renal crisis, or antibiotics for gastrointestinal symptoms. Proton pump inhibitors (PPIs) were prescribed to 87.3% of patients with gastrointestinal involvement, with an increase in use of both PPIs and prokinetic agents following the guideline update. Conclusions: Rheumatologists\u2019 adherence to the EULAR\/EUSTAR guidelines varied considerably, with 25% to 100% of eligible patients receiving the recommended treatments. Concordance improved in the management of PAH, ILD, and gastrointestinal involvement after the 2016 guideline update.<\/jats:p>","DOI":"10.3390\/jcm14144994","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T11:52:58Z","timestamp":1752580378000},"page":"4994","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rheumatologists\u2019 Adherence to EULAR Recommendations for Systemic Sclerosis Treatment: Experience of a Single Center in Serbia"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5683-2193","authenticated-orcid":false,"given":"Slavica","family":"Pavlov-Dolijanovic","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Institute of Rheumatology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8269-8526","authenticated-orcid":false,"given":"Ivan","family":"Jeremic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1037-1342","authenticated-orcid":false,"given":"Milan","family":"Bogojevic","sequence":"additional","affiliation":[{"name":"Clinical Center of Montenegro, Department of Rheumatology, 81110 Podgorica, Montenegro"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0590-8590","authenticated-orcid":false,"given":"Zoran","family":"Velickovic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7123-140X","authenticated-orcid":false,"given":"Mirjana","family":"Zlatkovic-Svenda","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Rheumatology, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine Foca, University of East Sarajevo,73300 Foca, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tijana","family":"Kojic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sasa","family":"Janjic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatjana","family":"Dimic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9885-1772","authenticated-orcid":false,"given":"Biljana","family":"Stojic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9828-1839","authenticated-orcid":false,"given":"Ana","family":"Markovic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4645-6074","authenticated-orcid":false,"given":"Andjela","family":"Perunicic","sequence":"additional","affiliation":[{"name":"Institute of Rheumatology, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6094-7306","authenticated-orcid":false,"given":"Aleksandra","family":"Djokovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital Medical Center Bezanijska kosa, Department of Cardiology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-4831","authenticated-orcid":false,"given":"Jelena","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5571-6211","authenticated-orcid":false,"given":"Nevena","family":"Baljosevic","sequence":"additional","affiliation":[{"name":"Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-973X","authenticated-orcid":false,"given":"Aleksandar","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Medical Center Zvezdara, Nephrology Department, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6489-5187","authenticated-orcid":false,"given":"Maja","family":"Omcikus","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Clinical Center of Serbia, Clinic for Pulmonary Diseases, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zorica Terzic","family":"Supic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Social Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4056-089X","authenticated-orcid":false,"given":"Natasa","family":"Milosavljevic","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Physics, Faculty of Agriculture, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4449-8969","authenticated-orcid":false,"given":"Goran","family":"Radunovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Rheumatology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/S0140-6736(22)01692-0","article-title":"Systemic 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