Interconnected B-cells and skin tissue in Systemic Sclerosis

Unlocking Scleroderma: New Insights into Skin Fibrosis & B Cell Biomarkers

Author's portrait.
Samir D’Costa in Health & Wellness August 2025 • 6 min read.

"Groundbreaking research identifies potential markers for predicting skin progression and disease activity in Systemic Sclerosis, offering hope for targeted therapies."


Systemic Sclerosis (SSc), also known as scleroderma, is a chronic autoimmune disease characterized by hardening and thickening of the skin (fibrosis) and internal organ damage. Managing SSc is challenging due to its variable progression and the lack of reliable markers to predict outcomes. Recent research sheds light on potential biomarkers that could revolutionize how we understand and treat this complex condition.

Two studies presented at the European League Against Rheumatism (EULAR) 2016 congress offer new perspectives on SSc. One study investigates the relationship between active skin disease and the progression of skin fibrosis, while the other explores the role of B cells in disease activity and organ involvement. Understanding these factors could lead to more targeted and effective therapies for SSc patients.

This article breaks down the key findings of these studies, translating complex scientific data into accessible information for patients, caregivers, and anyone interested in learning more about SSc. We'll explore the implications of these findings for predicting disease progression, monitoring disease activity, and developing new treatment strategies.

Decoding Skin Fibrosis: Is Active Skin Disease a Predictor of Progression?

Interconnected B-cells and skin tissue in Systemic Sclerosis

One of the major challenges in managing diffuse cutaneous SSc (dcSSc) is predicting which patients will experience rapid skin fibrosis progression. To address this, researchers conducted a longitudinal analysis of the EUSTAR registry, focusing on patients with dcSSc, a baseline mRSS (modified Rodnan skin score) of 7 or greater and available mRSS data at 12±2 months.

The study defined skin progression as an increase in mRSS of >5 points AND ≥25% within one year. They then analyzed various parameters of disease activity at baseline to see if they correlated with skin progression. These parameters included patient-reported worsening of skin, a modified skin thickness progression rate, progression of mRSS in the prior 12 months, the Valentini activity index, and inflammatory markers.

  • Patient-Reported Worsening: Surprisingly, patient-reported worsening of skin within the past month before baseline was not significantly associated with progressive skin disease after one year (p=0.774).
  • Modified Skin Progression Rate: The modified skin progression rate at baseline also did not differ significantly between progressive and non-progressive patients (p=0.323).
  • Prior Progression: Patients with skin fibrosis progression in the previous year were not more likely to show progression in the following year (p=0.385).
  • Other Activity Parameters: The Valentini activity index (p=0.673) and inflammatory markers like Erythrocyte Sedimentation Rate (p=0.287) and C-reactive protein (p=0.358) were not associated with skin fibrosis progression.
These findings suggest that recently active skin disease, as measured by these parameters, may not be a reliable predictor of further skin fibrosis progression in dcSSc patients. The researchers propose that patients with recent active skin disease might have already reached their peak skin score, making further progression less likely. This challenges the notion of using recently active skin disease as an enrichment criterion in clinical trials targeting skin fibrosis.

The Future of SSc Research: Targeting B Cells and Beyond

These studies highlight the complex nature of SSc and the need for more refined approaches to predicting disease progression and tailoring treatment strategies. The identification of CD19 and plasmablasts as potential biomarkers opens new avenues for research and could lead to the development of targeted therapies that modulate B cell activity.

Future research should focus on validating these findings in larger, more diverse cohorts of SSc patients. Additionally, studies are needed to investigate the mechanisms by which B cells contribute to disease activity and organ involvement in SSc. This may lead to the identification of novel therapeutic targets for this challenging condition.

While these findings offer hope for improved management of SSc, it's important to remember that SSc is a highly variable disease. Patients should work closely with their healthcare providers to develop individualized treatment plans that address their specific needs and disease manifestations. Continued research and collaboration are essential to unlocking the mysteries of SSc and improving the lives of those affected by this condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is Systemic Sclerosis (SSc), and what are its key characteristics?

Systemic Sclerosis (SSc), often called scleroderma, is a chronic autoimmune condition. It's characterized by the hardening and thickening of the skin (fibrosis) and can also damage internal organs. The condition's progression varies, and there's a lack of consistent markers to predict how it will unfold. Recent research aims to identify biomarkers that could help us better understand and treat SSc, improving the lives of those affected by this challenging disease.

2

How was the study group defined in this research regarding skin progression?

The study mentioned in the article looked at a group of patients with diffuse cutaneous Systemic Sclerosis (dcSSc) who had an initial modified Rodnan skin score (mRSS) of 7 or higher and mRSS data available at 12±2 months. Skin progression was defined as an increase in the mRSS of more than 5 points and a rise of at least 25% within one year. The researchers examined various disease activity parameters at the start to see if they related to skin progression, which included patient-reported worsening of skin, a modified skin thickness progression rate, progression of mRSS in the prior 12 months, the Valentini activity index, and inflammatory markers.

3

What were the main findings regarding active skin disease and its relation to skin fibrosis progression?

The research indicates that recently active skin disease, based on parameters like patient-reported worsening and skin thickness changes, may not reliably predict the progression of skin fibrosis in patients with dcSSc. The study found no significant associations between these factors and future skin fibrosis. This suggests that patients with recent active skin disease might have already reached their peak skin involvement, making further progression less likely. This challenges the common assumption of using recently active skin disease in clinical trials that target skin fibrosis.

4

Were inflammatory markers associated with skin fibrosis progression?

The Valentini activity index, Erythrocyte Sedimentation Rate (ESR), and C-reactive protein (CRP) were all investigated in the research. However, the research showed that they were not associated with skin fibrosis progression. This suggests that these measures, which are often used to assess inflammation and disease activity, may not be accurate in predicting the worsening of skin fibrosis in dcSSc patients. Other factors need to be considered to better predict disease progression and help in developing more effective treatments.

5

Why are B cells important in Systemic Sclerosis research?

B cells and their related biomarkers, such as CD19 and plasmablasts, are seen as significant in disease activity and organ involvement in Systemic Sclerosis. Identifying and targeting these specific B cell biomarkers opens new avenues for treatment research. These new approaches could lead to therapies that adjust B cell activity, offering more targeted and effective ways to treat Systemic Sclerosis. These findings show that the complexity of Systemic SSc requires detailed approaches and new strategies.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.