PREDICTIVE FACTORS OF PROGRESSION TO DEFINITE SYSTEMIC SCLEROSIS IN PATIENTS WITH RAYNAUD'S PHENOMENON AND VERY EARLY SSc: A NARRATIVE REVIEW

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Background Systemic sclerosis (SSc) is an autoimmune disease characterised by microcirculatory disorders, immune activation and fibrosis. Patients with Raynaud's phenomenon (RP) and features of very early SSc require particular attention, as progression to definite SSc may occur early in a subset of patients, while risk assessment remains a significant clinical challenge. Aims To analyse clinical, serological, capillaroscopic and molecular factors associated with progression to definite SSc in patients with RP and very early SSc. Methods A literature review was conducted using the PubMed and Scopus databases. Original studies assessing predictors of progression to definite SSc or clinically significant disease progression in patients with RP or very early SSc were qualitatively analysed. Results The highest reported risk of progression to definite SSc was observed in patients presenting a combination of puffy fingers, antinuclear antibodies, SSc-specific autoantibodies and abnormal nailfold capillaroscopy findings. Molecular biomarkers associated with extracellular matrix remodelling and immune system activation showed potential prognostic value but remain insufficiently validated for routine clinical use. Progression to definite SSc most often occurred during the first few years of follow-up. Conclusions Risk assessment for progression to definite SSc should be based on the combined interpretation of clinical features, antinuclear antibodies, SSc-specific autoantibodies and nailfold capillaroscopy findings. Molecular biomarkers may contribute to future prognostic assessment but currently require further validation.