Differentiating disease activity from damage in systemic sclerosis: it’s still early days!

Abstract

We read with great interest the article ‘Development and validation of the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI): a novel instrument to quantify organ damage in systemic sclerosis’ by Ferdowsi et al .1 We commend the authors’ to have come up with the much-needed concept of a damage index in systemic sclerosis. Differentiating activity from chronicity or damage is one of the key aspects in treatment of all rheumatological disorders and dictates the aggressiveness of treatment strategies employed. This differentiation is especially difficult in systemic sclerosis, owing to our incomplete understanding of the multifaceted pathogenesis of this complex disorder. What is currently believed to be irreversible (ie, damage) may in fact be reversible (ie, activity).\n\nThe SCTC-DI offers a promising outcome assessment tool for future clinical trials, but its clinical utility seems limited at present. Role of a damage index …