{
  "abstract": "Introduction Introduction: The 17-site modified Rodnan Skin Score (mRSS) is the primary outcome measure used in clinical practice and research for skin assessment in systemic sclerosis (SSc). However, this score has important limitations, including its high intra- and inter-observer variability, and low sensitivity to detect change over time.Objectives: To evaluate the progression of mRSS scores in the individual 17 skin sites, their sensitivity to change, and to explore the development of a reduced version of the mRSS in patients with early diffuse cutaneous SSc.Material and Methods Patients from the European Scleroderma Trials and Research (EUSTAR) cohort with dcSSc, fulfilling ACR/EULAR classification criteria, disease duration of <5 years from first non-Raynaud’s symptom, baseline mRSS >10, and a valid mRSS at 12±3 months after baseline assessment were included.We defined ‘clinically meaningful skin progression’ as an increase >5 units and >25% in total mRSS from baseline to follow-up visit. Mean change and the effect size (ES) for each individual skin site was calculated. Then, multiple linear regression was performed to identify the optimal reduced version of the mRSS. These models were then validated across subgroups of skin and lung progressors and non-progressors. All analyses were performed using SPSS version 27.0.1.0 and R Studio 2025, and p < 0.05 was taken as indicative of statistical significance.Results 328 patients were included. Over 12±3 months, mild local skin progression (+1 point, in any skin site) was most frequent in the upper arms (L/R: 15.9–17.1%) and forearms (L/R:14.3–15.5%) (table 1). Moderate to severe progression (+2 or +3 points in any skin site, respectively) occurred mostly in upper arms (L/R: 4.6%-5.2%) and chest (4.8%).The total mRSS had a large effect size (1.56), and similarly large effect sizes were observed in the upper arms, forearms, hands, and chest (ES: 0.86-1.42) (table 2).Reduced mRSS models using 7–9 sites demonstrated strong predictive performance for total mRSS (R2adj= 0.77–0.87), with the 6-site Left-mRSS showing the best performance among reduced models (R2adj = 0.88) (table 3). The 11-site model achieved the highest overall fit across all subgroups — including the total cohort, non-progressors, and skin progressors — with R2adj = 0.92.Conclusions Skin involvement showed a heterogeneous and variable progression across the 17-Rodnan skin sites. Our findings support the use of a reduced skin score to streamline skin assessment in early disease phase of dcSSc patients. Future studies are needed to investigate its applicability and performance in clinical trials.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Department, CHUC, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "Tania Santiago"
    },
    {
      "affiliations": [
        "Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Farmácia, Coimbra, Portugal",
        "QLV Research Consulting, Coimbra, Portugal"
      ],
      "name": "Cristiano Matos"
    },
    {
      "affiliations": [
        "Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France"
      ],
      "name": "Alain Lescoat"
    },
    {
      "affiliations": [
        "Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Manchester, UK",
        "Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Michael Hughes"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Rheumatology, Michigan, USA"
      ],
      "name": "Dinesh Khanna"
    },
    {
      "affiliations": [
        "Rheumatology Department, CHUC, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "José António Pereira da Silva"
    },
    {
      "affiliations": [
        "EUSTAR Collaborators, EUSTAR, * Other"
      ],
      "name": "EUSTAR Collaborators"
    }
  ],
  "title": "P.208 Rethinking skin assessment: analysis of individual rodnan skin sites scores in early diffuse systemic sclerosis using the EUSTAR cohort",
  "uid": "6f365f0a-f358-5ddc-9687-7fd262b5bfa7"
}