PASTUL questionnaire: a tool for self-assessment of scleroderma skin during the COVID-19 pandemic.

COVID-19 pandemic heralds the biggest challenge faced by health services worldwide and remote consultations are now widely implemented. Evaluation of skin involvement with modified Rodnan Skin Score (mRSS) is central in systemic sclerosis (SSc) as it is associated with internal organ manifestations and mortality, and an increase in mRSS requires attention in all SSc subsets.1 To monitor skin activity remotely during this pandemic we developed the PASTUL (Patient self-Assessment of Skin Thickness in Upper Limb) questionnaire. The questionnaire specifies a grading of skin (normal (0), mild (1), moderate (2), severely (3) thickened) at eight sites corresponding to mRSS with maximum score assigned to each site.2 We evaluated the PASTUL questionnaire on feasibility and validity in patients with SSc who had either a remote or face-to-face appointment at the Royal Free Hospital London, UK. Informed consent was obtained and patient instructions were provided. Scleroderma Skin Patient Reported Outcome (SSPRO),3 Scleroderma Health Assessment (SHAQ),4 the Scleroderma Functional Score (SFS)5 and the mRSS were collected to evaluate construct validity. The …