In this issue of The Journal, de Vries-Bouwstra, et al evaluated the level of agreement for the recommendations for systemic sclerosis (SSc; scleroderma) treatment from the European League Against Rheumatism (EULAR) Scleroderma Trials and Research group (EUSTAR)1,2. They studied the level of agreement on an 11-point scale (from 0 no agreement, to 10 full agreement) and surveyed 481 SSc experts from various organizations, most of whom had more than a decade of experience in the treatment of SSc. The response rate was about 55%, reasonable for this type of survey1. They found most items had a high level of agreement. Not surprisingly, there was high agreement in areas beyond debate, such as treating scleroderma renal crisis with angiotensin-converting enzyme inhibitors, and using proton pump inhibitors to treat symptoms of gastroesophageal reflux disease (GERD) and prevent GERD complications. There was also high agreement that patients with SSc who were using corticosteroids should have blood pressure and renal function monitored. This would be especially important in the diffuse cutaneous SSc (dcSSc) subset who are positive for anti-RNA polymerase antibody3, but many laboratories do not measure this antibody. …
Address correspondence to Dr. J.E. Pope, Division of Rheumatology, St. Joseph’s Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada. E-mail: janet.pope{at}sjhc.london.on.ca