Objectives: Psychological distress is commonly reported by patients affected by Spondyloarthritis (SpA), with >50% experiencing concomitant depression or anxiety. This case–control study aimed to investigate the psychological dimensions of SpA by assessing and comparing levels of kinesiophobia, depression and health-related quality of life (HRQoL) between SpA patients and a healthy control (HC) group. Methods: This cross-sectional case–control study included patients with SpA classified by Assessment of SpondyloArthritis international Society classification criteria and a group of HCs matched by sex and age. Inclusion criteria were age ≥18 years and stable therapy for at least 6 consecutive months. Data collection involved interviews and medical records. Psychological assessments were conducted using the Italian version of the Tampa Scale of Kinesiophobia-13 (TSK-IV), Beck’s Depression Inventory (BDI) and the 36-item Short Form (SF-36) Health Survey. Statistical analyses included t-test or Mann–Whitney U-test, chi-squared test, correlation analysis and multiple linear regression models. Results: Among 172 SpA patients and 94 HCs, SpA patients had significantly higher kinesiophobia (P < 0.001) and depression scores (P < 0.01). HRQoL was lower across all SF-36 domains except perceived health change. Axial SpA and peripheral SpA differed in diagnostic and therapeutic delay. Females showed greater kinesiophobia and depressive symptoms than males. Undergoing to second- or subsequent-line biologic therapy was linked to higher kinesiophobia and poorer HRQoL. BDI scores and diagnostic delay were key predictors of kinesiophobia in the SpA population. Conclusion: Kinesiophobia has a significant impact on psychological well-being in SpA patients. These findings highlight the need for targeted interventions that address not only the physical but also the psychological dimension of SpA.

Background: The 2011 Very Early Diagnosis of Systemic Sclerosis (VEDOSS) criteria include both patients at risk of progression and those with mild non-progressive forms of SSc. Early diastolic and systolic dysfunction can indicate myocardial fibrosis in SSc patients, yet data on myocardial impairment in the VEDOSS population are limited. Objectives: This study aimed to identify subclinical echocardiographic changes and predictive markers of cardiac dysfunction in both very early and mild-longstanding forms of VEDOSS. Methods: We conducted a cross-sectional observational study involving 61 patients meeting VEDOSS criteria followed up regularly within our Scleroderma referral center. Patients were categorized as early VEDOSS (e-VEDOSS) or mild-longstanding VEDOSS (ml-VEDOSS) based on disease duration (≥10 years). We analyzed clinical and demographic data, focusing on echocardiographic parameters such as the E/A ratio and left ventricular (LV) thickness. Statistical analyses included chi-square, Fischer exact, and student’s t tests, with a significance threshold of p < 0.05. Results: ml-VEDOSS patients were older and reported a higher burden of comorbidities. Autoantibody-positive patients exhibited lower E/A ratios and increased left atrial size. Late nailfold videocapillaroscopic pattern patients exhibited increased PWED thickening and aortic valve insufficiency. Notably, patients undergoing vasodilators experienced larger right atrial volume, while patients receiving Renin-Angiotensin-Aldosterone System (RAAS) inhibitors reported reduced E/A ratio. Multivariable analysis confirmed DLCO% as the sole predictor of both diastolic and systolic impairment in VEDOSS population. Conclusions: Careful monitoring of cardiac function in VEDOSS patients is crucial as subclinical alterations may occur even in the absence of symptoms. DLCO% emerged as an important predictor of LV diastolic dysfunction.

Background: The 2011 Very Early Diagnosis of Systemic Sclerosis (VEDOSS) criteria include patients at risk of progression and those with mild non-progressive forms of SSc. Early diastolic and systolic dysfunction can indicate myocardial fibrosis in SSc patients, yet data on myocardial impairment in the VEDOSS population are limited. Objectives: This study aimed to identify subclinical echocardiographic changes and predictive markers of cardiac dysfunction in both very early and mild-longstanding forms of VEDOSS. Methods: We conducted a cross-sectional observational study involving 61 patients meeting VEDOSS criteria followed up regularly within our Scleroderma referral center. Patients were categorized as early VEDOSS (e-VEDOSS) or mild-longstanding VEDOSS (ml-VEDOSS) based on disease duration ( ≥ 10 years). We analyzed clinical and demographic data, focusing on echocardiographic parameters such as the E/A ratio and left ventricular (LV) thickness. Statistical analyses included Chi-square, Fischer exact, and Student's T tests, with a significance threshold of p<0.05. Results: ml-VEDOSS patients were older and reported a higher burden of comorbidities. Autoantibody-positive patients exhibited lower E/A ratios and increased left atrial size. Late nailfold videocapillaroscopic pattern patients exhibited increased PWED thickening and aortic valve insufficiency. Notably, patients undergoing vasodilators experienced larger right atrial volume, while patient receiving Renin-Angiotensin-Aldosterone System (RAAS) inhibitors reported reduced E/A ratio. Multivariable analysis confirmed DLCO% as the sole predictor of both diastolic and systolic impairment in VEDOSS population. Conclusion: Careful monitoring of cardiac function in VEDOSS patients is crucial as subclinical alterations may occur even in the absence of symptoms. DLCO% emerged as an important predictor of LV diastolic dysfunction.

Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima–Media Thickness (IMT). Methods: A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid–vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid–vertebral US findings. Results: Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, p = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, p = 0.002). Right ICA RI vas elevated in the DU group (p = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (p < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (p = 0.012) and right-sided ICA RI > 0.75 (p = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, p = 0.043) and carotid plaque presence at any side (OR 14.34, p = 0.012). Conclusions: A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice.

Objective: The very early diagnosis of systemic sclerosis (SSc; VEDOSS) criteria aim to identify patients at risk of evolving into SSc. The predictive value of diffusing capacity of the lungs for carbon monoxide (DL co) and forced vital capacity (FVC) remains poorly characterized. This study aimed to evaluate whether baseline pulmonary function test (PFT) alterations, especially DL co , predict progression to SSc and to examine longitudinal PFT changes in patients with stable VEDOSS over time. Methods: A retrospective longitudinal study was conducted including 73 patients with VEDOSS. Patients were stratified by serologic, capillaroscopic, and clinical features. Annual PFT follow‐up was performed at our center. Progression to SSc was defined according to the 2013 American College of Rheumatology/EULAR criteria. Kaplan–Meier curves were generated to evaluate progression rates according to baseline DL co /single breath (SB)%, using 70% as cutoff, and to evaluate time‐dependent survival of both DL co % and FVC% decline according to the presence or the absence of SSc‐specific antibodies (SSc‐Ab), active‐late nailfold videocapillaroscopic (NVC) patterns, and puffy fingers. A Cox proportional hazards regression model was used to assess the independent association between baseline DL co /SB (%) and progression‐free survival, adjusting for SSc‐Ab+, NVC patterns, and the presence of puffy fingers. Results: Over a median follow‐up of five years (maximum 11 years), 12% of patients transitioned to SSc. All progressors were SSc‐Ab+ and had lower baseline DL co /SB% values (68.2% vs 81.2%, P = 0.004). A DL co /SB <70% was strongly associated with increased risk of progression toward SSc over time (7.7 vs 10.2 years, log‐rank = 0.007). In patients with stable VEDOSS, the time‐dependent decline of DL co /SB% was shorter in SSc‐Ab+ group (8 vs 10.4 years, log‐rank = 0.032). FVC% also declined in the cohort without any influence of disease‐specific variables. Cox regression showed that the SSc‐Ab+ and scleroderma NVC pattern were the main contributors to progression toward definite SSc. Conclusion: Baseline DL co /SB <70% is a potential marker of disease progression in VEDOSS; however, subtle progressive pulmonary function decline may occur even in stable patients. image

Letters to the Editor; Authors: E. Capparelli, E. Zaccara, D. Bompane, L. Castelnovo, A. Tamburello, P. Faggioli