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Interleukin (IL)33 and its receptor ST2 have been involved in the pathogenesis of several conditions, including arthritis. The aim of the study was to evaluate the association between IL33 or soluble ST2 (sST2) serum levels and systemic sclerosis (SSc) articular involvement. IL33 and sST2 serum levels were measured in 64 SSc patients and 24 HC matched for sex and age. Articular involvement assessed by using Disease Activity Score 28 based on erythrocyte sedimentation rate (DAS28-ESR), presence of tendon friction rubs (TFRs) and finger-to-palm (FTP) distance. sST2 serum levels were significantly higher in SSc patients with DAS28-ESR > 3.2 than in SSc patients with DAS28-ESR⩽3.2 [9726.1 (IQR 7746.5 - 14,953.5) pg/mL vs 7611.7 (IQR 5162.6 -11,036.7) pg/mL; p < 0.05]. sST2 serum levels were significantly higher in SSc patients with TFRs compared to SSc patients without TFRs [9726.1 (IQR 7746.5 - 14,953.5) pg/mL vs 7426.4 (IQR 5145.9 - 10,593.5) pg/mL; p < 0.01] and in SSc patients with FTP ≥ 1 cm compared to SSc patients with FTP < 1 cm [9683.7 (IQR 8067.2 - 16,387.6) pg/mL vs 7679.1 (IQR 5246.1 - 11,472.2) pg/mL; p < 0.05]. No significant association was observed between IL33 and DAS28-ESR, TFRs and FTP. A slightly positive linear correlation was found between sST2 and Disease Activity Index (r = 0.294, p < 0.05) and Disease Severity Scale (r = 0.265, p < 0.05). sST2 serum levels were positively correlated with DAS28-ESR (r = 0.371, p < 0.01). Elevated sST2 serum levels were associated with higher articular disease activity, TFRs and hand dysfunction, suggesting that sST2 might have a role in the pathogenesis of SSc articular involvement. Key Points • In SSc patients elevated serum levels of sST2 were associated with higher articular disease activity • High serum levels of sST2 were reported in SSc patients with TFRs and hand dysfunction • sST2 might have a role in the pathogenesis of SSc articular involvement., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objectives: Systemic sclerosis (SSc) patients are at risk for a severe disease course during SARS-CoV-2 infection either due to comorbidities or immunosuppression. The availability of SARS-CoV-2 vaccines is crucial for the prevention of this hard-to-treat illness. The aim of this study is to assess the humoral response after mRNA vaccination against SARS-CoV-2 in SSc patients., Method: Seropositivity rate and serum IgG levels were evaluated 1 month (t1) and 3 months (t3) after the second dose of vaccine in a cohort of SSc patients and healthy controls (HC). Differences were made with Student's or Mann-Whitney's t-test and with the chi-square or Fisher exact test. Logistic regression model including immunosuppressive treatments (corticosteroids, CCS; mycophenolate mofetil, MMF; methotrexate, MTX; rituximab, RTX) was built to assess the predictivity for seropositivity., Results: The seropositivity rate was similar in 78 SSc patients compared to 35 HC at t1 but lower at t3. SSc patients had lower serum IgG levels than HC at t1 but not at t3. SSc patients treated with immunosuppressive therapy showed both a lower seropositive rate (t1, 90.3% vs 100%; t3, 87.1% vs 97.9%; p < 0.05) and serum IgG levels than untreated patients both at t1 [851 BAU/ml (IQR 294-1950) vs 1930 BAU/ml (IQR 1420-3020); p < 0.001] and t3 [266 BAU/ml (IQR 91.7-597) vs 706 BAU/ml (IQR 455-1330); p < 0.001]. In logistic regression analysis, only MTX was significant [OR 39.912 (95% CI 1.772-898.728); p < 0.05]., Conclusions: SSc patients treated with MTX had a lower serological response to mRNA vaccine, and even low doses of CCS can adversely affect antibody titer and vaccination response. Key Points • SSc patients are able to produce vaccine-induced antibodies after mRNA vaccination. • In SSc patients, clinical characteristics of disease did not influence seropositivity rate. • In SSc patients, even low doses of CCS can adversely affect antibody titer and vaccination response. • In SSc patients, MTX treatment is mainly associated with reduced seropositivity and lower serum IgG levels., (© 2022. The Author(s).)

Introduction/objectives: Gastrointestinal tract (GIT) involvement is frequently observed in systemic sclerosis (SSc) and may lead to nutritional impairment. The aim of the study was to assess the prevalence of symptoms related to GIT involvement and to analyze the possible association between gastrointestinal symptoms and low muscularity in SSc patients., Methods: Sixty-nine consecutive patients (60 females, median age 53 (IQR 43-63), body mass index (BMI) 23.2 (IQR 20.9-24.6) kg/m 2 ) with diagnosis of SSc admitted to our Scleroderma Unit were enrolled. Clinical status, anthropometric data, and bioelectrical impedance (Inbody 770, USA) analysis-assessed Fat-Free Mass Index (FFMI) were recorded upon enrollment. UCLA questionnaire was used to quantify GIT involvement with seven specific scales., Results: Mean FFMI was 16.2 kg/m 2 (IQR 15.2-17.6). The median UCLA total score was 0.53 (IQR 0.19-0.89). FFMI showed a significant negative correlation with UCLA total score (r = -0.29, p = 0.016) and UCLA distention/bloating (r = -0.35, p < 0.01). In 16 patients (23.1%), FFMI was reduced and UCLA distention/bloating was significantly higher (p = 0.039) in SSc patients with lower FFMI [1.75 (IQR 0.75-2.12) vs 0.75 (IQR 0.25-1.75)]. At multiple linear regression model, FFMI showed association with UCLA distention/bloating [beta coefficient - 0.315 (95% CI of beta coefficient: -0.591; -0.039), p = 0.026], BMI [beta coefficient 0.259 (95% CI of beta coefficient: 0.163; 0.355), p = 0.001], and disease duration [beta coefficient - 0.033 (95% CI of beta coefficient: -0.059; -0.007), p = 0.015]., Conclusions: In SSc, low FFMI is associated with symptoms related to GIT involvement, in particular with distension/bloating. Key Points • FFMI is associated with symptoms related to GIT involvement. • Low FFMI is associated with symptoms related to UCLA distention/bloating. • Malnutrition is not associated with symptoms related to GIT involvement., (© 2022. The Author(s).)

Lung ultrasound (LUS) correlates with chest high-resolution computed tomography (HRCT) findings in the diagnosis of interstitial lung disease (ILD) in systemic sclerosis (SSc). The aim of this study is to evaluate the predictive value of LUS in the progression of ILD. At baseline, forty-one SSc patients underwent HRCT, LUS for detection of B-lines, and pulmonary function test (PFTs). PFTs were performed also after 12 months to evaluate pulmonary function deterioration. In multiple regression analysis, positive correlation exists between the number of B-lines and HRCT score (r = 0.51, p < 0.05), conversely a negative correlation exists between number of B-lines and carbon monoxide diffusing capacity (DLCO) (r = - 0.49, p < 0.05) and FVC (r = - 0.42, p < 0.05). The number of B-lines significantly (p < 0.05) increased with progression of digital microvascular damage. At 12 months, a positive correlation exists between number of B-lines and delta of DLCO. The ROC curves demonstrated a good accuracy of worsened DLCO prediction for Delta DLCO (0.72, p < 0.05 95% CI 0.56-0.88). The sum of B-lines correlates with the radiological score evaluated by HRCT. We also demonstrate that the number of B-lines can predict the worsening of the ILD. Although HRCT is the gold standard technique for assessing ILD, the LUS could become a useful tool for guiding the use of HRCT.Key Points• In systemic sclerosis patients, the number of B-lines can predict the worsening of the interstitial lung disease• High-resolution computed tomography of chest is the gold standard technique for assessing interstitial lung disease• Lung ultrasound could become a useful tool for guiding the use of high-resolution computed tomography of chest.