An international electronic survey of 756 general rheumatologists and 250 SSc experts examined current immunosuppressive prescribing patterns in limited cutaneous systemic sclerosis (lcSSc) in the absence of internal organ complications.
139 respondents (14% response rate; 94% rheumatologists): 58% reported at least sometimes using immunosuppressants for cutaneous symptoms in lcSSc, while only 21% did so to prevent future complications. Over 70% would treat in the presence of tendon friction rubs, new skin thickening, rising mRSS, or mRSS ≥15. Top first-line choices were mycophenolate mofetil (47%), methotrexate (28%), and hydroxychloroquine (20%).
Very low response rate (14%) introduces significant selection bias. Survey design cannot capture actual prescribing behavior or patient outcomes. Generalizability is uncertain given over-representation of rheumatologists and unclear geographic distribution.
There is wide variation in how rheumatologists use immunosuppressants in lcSSc — most agree to treat when signs like tendon friction rubs or rising mRSS ≥15 are present, but practice diverges sharply for milder or subclinical disease. High-quality trials are needed before a standard approach can be recommended.
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