Management Challenges in the Early Systemic Sclerosis Population: Navigating Side Effects of Therapeutics and Approach to Diarrhea

Very early systemic sclerosis (VEDOSS) is characterized by Raynaud Phenomenon (RP), puffy fingers, anti-nuclear antibodies (ANA), disease-specific autoantibodies and/or pathognomonic microvascular alterations detected by capillaroscopy, and when applied to clinical practice allows the treating physician to identify patients earlier in the systemic sclerosis (SSc) disease process. Literature data supports that internal organ involvement in SSc is early and subclinical, therefore VEDOSS criteria helps the physician to start an early evaluation of internal organ involvement. In the VEDOSS population, calcium channel blocker (CCB) use for Raynaud’s phenomenon is often the first initiated therapy, which commonly has the side effect of gastroesophageal reflux (GERD). Gastrointestinal complaints, including GERD, are common in SSc patients in the very early phases of disease, and proton pump inhibitors (PPI) are commonly used as a therapeutic. Another common therapeutic that is prescribed to VEDOSS patients for skin and joint complaints is methotrexate. As such, understanding how to implement therapeutics and investigate diarrhea in early SSc is important.