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Currently, there are no well-validated, prospective disease trajectory models to predict progressive disease in juvenile systemic sclerosis (jSSc). The rarity 1 and clinical heterogeneity of jSSc2 pose significant challenges to developing robust predictive tools. However, retrospective cohort studies and clinical observations suggest that specific features present at diagnosis—such as early internal organ involvement (particularly interstitial lung disease (ILD) or cardiac manifestations), rapid progression of skin thickening and younger age at disease onset—may be associated with a more aggressive disease course3 4