The COVID-19 pandemic highlights the need for a psychological support in systemic sclerosis patients

Systemic sclerosis (SSc) in a chronic autoimmune disease characterised by internal organs damage and skin fibrosis potentially leading to disability and reducing quality of life (QoL). In SSc, patients must face the fear and uncertainty induced by the disease chronic progression and the changes of the physical appearance leading to body image distress (1). The diminished life expectancy, the body pain, the gastrointestinal involvement and the reduced health-related QoL explains the higher risk of depression observed in SSc patients (2- 4). Depression is reported to be more frequent in women than in men, and is mainly due to decreased QoL, fatigue and reduced physical activity. However it does not impact patients survival (5, 6). Older age, diffuse cutaneous subset (dcSSc) and pulmonary arterial hypertension (PAH) are the major determinants of a lower health-related QoL when measured by the Short Form 36 (SF-36). Moreover, a strong association between disability and depressive symptoms is often reported (7-9). Illness-related uncertainty is one of the main stressors, influencing the behaviour and disease perception, thus leading to an excessive self-examination, ultimately increasing anxiety symptoms (2). Also anxiety is more frequent in SSc female than in male and unrelated to disease severity (10, 11). In the last years, numerous studies reported an impaired health-related QoL and an increased prevalence of psychiatric symptoms among SSc patients (5, 12, 13). In addition, data on psychosocial aspects as body image distress, sexual function and disability are increased (14), reinforcing the need to pay more attention to psychological aspects in SSc patients in routine clinical practice. In the last three years, the attention to patients mental health has globally grown and COVID-19 pandemic has increased the need for the evaluation of psychological symptoms, forcing clinicians to address the problem in every day practice, dealing therefore with an increasing number of patients characterised by psychiatric symptoms (15). Pre-existing medical conditions exposed patients with chronic diseases at major risk of COVID-19 infection and complications. For this reason, SSc patients are at greater risk for COVID19-related stress, boredom, grief, fear, depression and anxiety from the earliest phase of the pandemic (15, 16). In the management of patients with chronic diseases as SSc, the COVID-19 has quickly prompted the attention on psychological aspects, making the clinician aware that a new vision and care of SSc patients was mandatory. Recently, Henry et al. (17) evaluated anxiety and depression in SSc patients in the pre-COVID-19 and during the COVID-19 through March 2021 and assessed the trend of anxiety, depression, fear and loneliness across the pandemic era through March 2022 in patients enrolled in the Scleroderma Patient-centred Intervention Network (SPIN). A previous study focussed the attention on mental health of SSc patients in the early phase of pandemic and on its comparison with pre-COVID-19 status. The analysis of SSc patients from the SPIN Cohort evaluated anxiety and depression symptoms before and after the pandemic reporting an increase in anxiety but not in depression during the COVID-19 (18). Also other data from previous studies confirmed the attention on SSc patients mental health in the first phases of pandemic and on the different support Editorial The COVID-19 pandemic highlights the need for a psychological support in systemic sclerosis patients G. Lepri1 , M. Orlandi1 , S. Bellando-Randone1 , M. Matucci-Cerinic1,2, S. Guiducci1 1576 Clinical and Experimental Rheumatology 2023 COVID-19 and psychological support in SSc patients / G. Lepri et al. programmes conducted to aid patients with chronic disease in such a s