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Background: Progression and expansion of skin fibrosis are the most important characteristics in determining clinical responses and prognosis of Systemic Sclerosis
(SSc). Using modified Rodnan skin score (mRSS) can not rapidly detect a slight changes of skin fibrosis in SSc patients. Biomarker assessment is needed to make a more objective, quantitative and rapid evaluation of the changes. Suggested potential useful biomarker is
B-cell Activating Factor (BAFF), a positive regulator of B cell survival and maturation process. This study aimed to evaluate correlation between skin fibrosis based on mRSS and BAFF serum in SSc patients.

Methods: We used cross sectional methods. Enrolled all patients who met ACR EULAR 2013 criteria for SSc in Rheumatology Clinic Hasan Sadikin Hospital, Bandung, from November 2015 to March 2016. Subjects underwent medical record review, physical examination,
mRSS measurement by rheumathologist, and blood tests. Data were analized using Rank-Spearman Correlation.

Results: Thirty seven subjects, with mean age 40+10 years old. Subjects consisted of 23(62.2%) limited SSc and 14(37.8%) diffuse SSc. Mean BAFF serum was 1160.2+424.7 pg/mL, no statistical difference were found between limited and diffuse type (p=0.662).
Median mRSS results was 16 ranged from 2 to 36.Correlation between mRSS and BAFF serum was not significant (r=0.077; p=0.326).

Conclusion: There is no correlation between mRSS and BAFF serum in systemic sclerosis at Hasan Sadikin Hospital.
Keywords: mRSS, BAFF, Systemic Sclerosis

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How to Cite
Alfarish, M. A., Dewi, S., Hamijoyo, L., & Wachjudi, R. G. (2017). Correlation Betweeen Skin Fibrosis Based On Modified Rodnan Skin Score And B-Cell Activating Factor Serum In Systemic Sclerosis. Indonesian Journal of Rheumatology, 9(1).


  1. Bernatsky S, Hudson M, Panopalis P, Clarke AE, Pope J, Leclercq S, et al. The cost of systemic sclerosis. Arthritis Care & Research. 2009;61(1):119- 23.
  2. Castro SV, Jimenez SA. Biomarkers in systemic sclerosis. Biomarkers in medicine. 2010;4(1):133-47.
  3. Czirjak L, Foeldvari I, Muller-Ladner U. Skin involvement in systemic sclerosis. Rheumatology (Oxford, England). 2008 Oct;47 Suppl 5:v44-5.
  4. Czirjak L, Nagy Z, Aringer M, Riemekasten G, Matucci-Cerinic M, Furst DE. The EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis. Annals of the rheumatic diseases. 2007 Jul;66(7):966-9.
  5. Moinzadeh P, Denton C, Abraham D, Ong V, Hunzelmann N, Eckes B, et al. Biomarkers for skin involvement and fibrotic activity in scleroderma. Journal of the European Academy of Dermatology and Venereology. 2012;26(3):267-76.
  6. Lafyatis R. Application of Biomarkers to Clinical Trials in Systemic Sclerosis. Current Rheumatology Reports. 2012;14(1):47-55.
  7. Mariette X. How does BAFF activate B cells in patients with autoimmune diseases.
  8. Bosello S, Pers J, Rochas C, Devauchelle V, De Santis M, Daridon C, et al. BAFF and rheumatic autoimmune disorders: implications for disease management and therapy. International journal of immunopathology and pharmacology. 2007;20(1):1.
  9. François A, Chatelus E, Wachsmann D, Sibilia J, Bahram S, Alsaleh G, et al. B lymphocytes and B-cell activating factor promote collagen and profibrotic markers expression by dermal fibroblasts in systemic sclerosis. Arthritis Res Ther. 2013;15:R168.
  10. Matsushita T, Hasegawa M, Yanaba K, Kodera M, Takehara K, Sato S. Elevated serum BAFF levels in patients with systemic sclerosis: enhanced BAFF signaling in systemic sclerosis B lymphocytes. Arthritis & Rheumatism. 2006;54(1):192-201.
  11. Mackay F, Browning JL. BAFF: a fundamental survival factor for B cells. Nature Reviews Immunology. 2002;2(7):465-75.
  12. Ng LG, Sutherland AP, Newton R, Qian F, Cachero TG, Scott ML, et al. B cell-activating factor belonging to the TNF family (BAFF)-R is the principal BAFF receptor facilitating BAFF costimulation of circulating T and B cells. Journal of immunology (Baltimore, Md : 1950). 2004 Jul 15;173(2):807-17.
  13. Krivosikova M, Dallos T, Maslinski W, Buc M. B cell activating factor, its role in autoimmunity, and targeting in autoimmune diseases. Bratislavské lekárske listy. 2008; 110(3):137-45.
  14. Fawzy SM, Gheita TA, El-Nabarawy E, El-Demellawy HH, Shaker OG. Serum BAFF level and its correlations with various disease parameters in patients with systemic sclerosis and systemic lupus erythematosus. The Egyptian Rheumatologist. 2011 1//; 33(1):45-51.
  15. Abdo MS, Mohammed RHA, Raslan HM, Gaber SM. Serum B-cell activating factor assessment in a population of Egyptian patients with systemic sclerosis. International Journal of Rheumatic Diseases. 2013;16(2):148-56.
  16. Varga J. Systemic sclerosis: epidemiology, pathology and pathogenesis. Primer on rheumatic diseases 13th ed Atlanta: Springer. 2008:351-8.
  17. Denton C, Black C, Korn J, De Crombrugghe B. Systemic sclerosis: current pathogenetic concepts and future prospects for targeted therapy. The Lancet. 1996; 347(9013):1453-8.
  18. Gabrielli A, Avvedimento EV, Krieg T. Scleroderma. New England Journal of Medicine. 2009;360(19):1989-2003.
  19. Mayes MD. Systemic sclerosis. Primer on the rheumatic diseases. Springer; 2008. hlm. 343-62.
  20. Manno R, Boin F. Immunotherapy of systemic sclerosis. Immunotherapy. 2010 Nov;2(6):863-78.
  21. Kowal-Bielecka O, Landewe R, Avouac J, Chwiesko S, Miniati I, Czirjak L, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Annals of the rheumatic diseases. 2009;68(5):620-8.
  22. Van den Hoogen F, Boerbooms A, Swaak A, Rasker J, Van Lier H, Van De Putte L. Comparison of methotrexate with placebo in the treatment of systemic sclerosis: a 24 week randomized double-blind trial, followed by a 24 week observational trial. Rheumatology. 1996;35(4):364-72.
  23. Pope JE, Bellamy N, Seibold JR, Baron M, Ellman M, Carette S, et al. A randomized, controlled trial of methotrexate versus placebo in early diffuse scleroderma. Arthritis & Rheumatism. 2001;44(6):1351-8.
  24. Vitiello M, Abuchar A, Santana N, Dehesa L, Kerdel FA. An Update on the Treatment of the Cutaneous Manifestations of Systemic Sclerosis: The Dermatologist’s Point of View. Journal of Clinical & AestheticDermatology. 2012;5(7).