







































 

_____________________________________________________________________________________________________ 
 
++ Professor; 
*Corresponding author: E-mail: Docteurlakrafiyasser@gmail.com, Docteuryasser273@hotmail.com; 
 
Cite as: Yassir, Lakrafi, Benhayoun Basma, Cherfouf Rihabe, Bouroyene El Mehdi, Barakat Leila, Benzakour Merieme, Khadija 
Echchilali, Mina Moudatir, and Hassan El Kabli. 2024. “A 6-Year Statistical Study of Systemic Sclerosis in the Region of 
Casablanca-Settat, Morocco”. Asian Journal of Immunology 7 (1):159-74. https://journalaji.com/index.php/AJI/article/view/140. 
 

 
 

Asian Journal of Immunology 
 
Volume 7, Issue 1, Page 159-174, 2024; Article no.AJI.122682 
 

 
 

 

 

A 6-Year Statistical Study of Systemic 
Sclerosis in the Region of Casablanca-

Settat, Morocco 
 

Lakrafi Yassir a*, Benhayoun Basma b, Cherfouf Rihabe b, 
Bouroyene El Mehdi a, Barakat Leila b++,  

Benzakour Merieme b++, Khadija Echchilali b++,  

Mina Moudatir b++ and Hassan El Kabli b++ 

 
a Internal Medicine Department and Geriatrics Unit of the Ibn Rochd University Hospital Center in 

Casablanca, Morocco. 
b Internal Medicine Department and Geriatrics Unit P38 of the Ibn Rochd University Hospital Center in 

Casablanca, Morocco. 
 

Authors’ contributions  
 

This work was carried out in collaboration among all authors. All authors read and approved the final 
manuscript. 

 
Article Information 

 
DOI: https://doi.org/10.9734/aji/2024/v7i1140  

 
Open Peer Review History: 

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer 
review comments, different versions of the manuscript, comments of the editors, etc are available here: 

https://www.sdiarticle5.com/review-history/122682 
 
 

 

Received: 03/07/2024 
Accepted: 06/09/2024 
Published: 16/09/2024 

 
 
ABSTRACT 
 

Systemic sclerosis is a non-organ-specific autoimmune disease of the connective tissue, 
characterized by excessive production of collagen leading to fibrosis of the skin as well as organs 
such as the lung, it is responsible for aesthetic discomfort, an alteration of the functional prognosis 
and potentially life-threatening due to damage to the heart, lungs and kidneys. We, therefore, 

Original Research Article 

mailto:Docteurlakrafiyasser@gmail.com
https://doi.org/10.9734/aji/2024/v7i1140
https://www.sdiarticle5.com/review-history/122682


 
 
 
 

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160 

 

decided to carry out a retrospective study extending over 6 years at the Internal Medicine 
Department and Geriatrics Unit of the Ibn Rochd University Hospital Center in Casablanca that 
concerned the medical files of 2164, in order to see if systemic scleroderma in our region presented 
any particularities. We noted that scleroderma was relatively rare in our context with only 42 
patients in whom the diagnosis was made in 06 years with a female predominance (the sex ratio in 
our studies was 4.25 women for 1 man), we noticed that the provinces the most concerned are 
Casablanca, El Jadida and Settat with a predominance in urban areas, that the family history of 
scleroderma or autoimmune disease is weakly present in our context, the main profession at risk 
found in our context is automobile sheet metal work and it concerned 3 male patients (7.14%), 
exposure to tobacco was however present in 11 patients or 26.9%. We also noted that the first 
symptoms were diverse (arthralgia, myalgia, Raynaud's phenomenon) and often appeared between 
1 and 5 years (in 59.6% of patients) before the diagnosis to be made. The clinical picture is classic 
with varied skin involvement in 100% of our patients with abnormalities on capillaroscopy in 95.2% 
of our patients, orofacial involvement in 54.8% of patients, muscular involvement in 57.1%, joint 
damage in 64.3%, bone damage in 23.8%, lung damage in 61.9%, heart damage in 23.8%, kidney 
damage in 26.2%, digestive damage in 54.8%, and urogenital involvement in 33.3% of patients. 7 
patients died (16.66%), 3 patients (7.14%) had progression of the disease leading to complications, 
and 20 patients (47.61%) reported improvement while the disease remained stationary in 11 
patients (26.19%). 
 

 

Keywords: Systemic scleroderma; autoimmune disease; connective tissue; microcirculation. 

 
1. INTRODUCTION 
 
Systemic scleroderma is a non-organ-specific 
autoimmune disease of the connective tissue 
characterized by damage to the microcirculation 
leading to Raynaud’s Phenomenon and 
excessive collagen production resulting in 
fibrosis of various organs. It is a rare condition 
with a poorly known prevalence and 
predominantly affecting women, with a female-
male ratio ranging from 3:1 to 8:1. This condition 
not only impacts aesthetic and functional aspects 
but also vital due to the potential involvement of 
the lungs, heart and kidneys [1]. 
 
Our work consists of a retrospective study 
reporting the different particularities of 
scleroderma in the Casablanca-Settat region. 
 

2. MATERIALS AND METHODS 
 
Our work consists of a retrospective study over 6 
years extending from January 1 of 2018, to 
December 31 of 2023, carried out in the Internal 
Medicine and Geriatrics Unit of the Ibn Rochd 
University Hospital Center in Casablanca and 
which drains patients from the region of 
Casablanca-Settat and which concerned the 
medical files of 2164 patient with 42 patients in 
whom scleroderma was newly diagnosed. The 
objective of our study is to determine the different 
epidemiological particularities of scleroderma, 
the different visceral damage, the response to 
different treatments and the evolution of this 

condition, as well as the impact of this condition 
on the fertility of patients. For this we used the 
following operating sheet created using Google 
Forms. 
 

3. RESULTS 
 
During the period of 06 years from January 1, 
2018 to December 31, 2023 we welcomed 2164 
patients to the Internal Medicine and Geriatrics 
Unit of the Ibn Rochd University Hospital Center 
in Casablanca for different reasons and the 
diagnosis of Systemic Scleroderma was retained 
according to the ACR/EULAR 2013 criteria in 42 
patients, which represents 1.94% of all 
admissions to the service during this period, of 
which 8 were men and 34 were women. 
 
The skin manifestations observed in patients 
included Raynaud's phenomenon in 95.2%, pulp 
ulceration in 35.7%, pulp scarring in 61.9%, 
sausage-like fingers in 54.8%, skin sclerosis not 
extending beyond the MCP joints in 45.2% and 
extending beyond the MCP joints in 45.2%, 
thinning of the lips and nose in 40.5%, loss of 
forehead wrinkles in 23.8%, exaggerated perioral 
folds in 14.3%, skin hypopigmentation in 11.9%, 
telangiectasia in 28.6%, and calcinosis in 4.8%. 
 

4. DISCUSSION 
 
Scleroderma is a non-specific autoimmune 
disease of connective tissue, which makes it a 
systemic disease. It is characterized by damage 



 
 
 
 

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to the microcirculation, the most classic of which 
is Raynaud's phenomenon, as well as excessive 
production of collagen leading to organ fibrosis, 
the most common of which is pulmonary fibrosis. 
It has an aesthetic and functional prognosis and 

can be life-threatening due to damage to the 
kidneys, lungs and heart. The pathophysiological 
mechanism is partially understood, and the 
etiology is unknown. [1] 

 

 
 

Fig. 1. Distribution of patients according to gender 
 

 

 
 

Fig. 2. Distribution of patients according to rural/urban origin 
71.4% (n=30) were of urban origin, while 28.6% (n=12) were of rural origin. 

 

 
 

Fig. 3. Distribution of patients according to province of origin 
35.7% (n=15) were from Casablanca, 28.6% (n=12) from El Jadida, 19% (n=8) from Settat, 4.8% (n=2) from each 

of Mohammedia, Médiouna, and Sidi Bennour, and 2.4% (n=1) from Berrechid 
 
 

35.70%

28.60%

19%

4.80%

4.80% 4.80% 2.40%

Distribution of patients according to province of origin

Casablanca El Jadida Settat
Mohammedia Mediouna Sidi Bennour
Berrechid



 
 
 
 

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Fig. 4. Percentage of patients with a family history of systemic sclerosis 
85.7% (n=36) had no family history of systemic scleroderma, 9.5% (n=4) were unaware if they had any, and 4.8% 

(n=2) reported a family history of scleroderma 

 

 
 

Fig. 5.  Percentage of patients with a family history of autoimmune disease other than 
scleroderma 

76.2% (n=32) had no family history of autoimmune disease, 14.3% (n=6) had at least one family member with an 
autoimmune disease, and 9.5% (n=4) were unaware if they had a family history of autoimmune disease 

 

 
 

Fig. 6. Distribution of patients according to age of onset of first symptoms 
The age of onset of the first symptoms was below 15 years in 7.1% of patients, between 16 and 35 years in 

28.5% of cases, between 36 and 55 years in 40.5% of cases, between 56 and 65 years in 14.3%, and over 65 
years in 9.5% of cases 

 
 

4.80%

85.70%

9.50%

Percentage of patients with a family history of systemic 
sclerosis

Yes No Unknown



 
 
 
 

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163 

 

 
 

Fig. 7. Summary diagram of the initial symptoms of systemic scleroderma in our patients 
The initial symptoms included Raynaud's phenomenon in 83.3% of cases, skin sclerosis in 42.9%, dyspnea in 

23.8%, myalgia in 9.5%, and arthralgia in 35.7% 

 

 
 

Fig. 8. Distribution of patients according to age of diagnosis 
The age at diagnosis was between 16 and 35 years in 19.1% of cases, between 36 and 55 years in 52.3%, 

between 56 and 65 years in 16.7%, and over 65 years in 11.9% 

 
Table 1. Results of the immunological assessment in our patients 

 

Immunological assessment Number of 
patients 

Percentage 

Immunological assessment not done 1 2.4% 

Negative immunological test 3 7.1% 

Positive Anti-Nuclear Antibodies 38 90.5% 

Anti-Topo-Isomerase/Scl 70 antibodies positive 12 31.57% 

Anti-RNA polymerase III antibodies positive 7 18.42% 

Positive Anti-Centromere Antibodies 11 28.94% 

Anti-Centromere Antibodies + Positive Anti-Scl 70 Antibodies 3 7.89% 

Anti-Centromere Antibodies + Positive Anti-RNA-Olymerase 
III Antibodies 

3 7.89% 

Anti Scl 70 antibodies + Anti RNA-polymerase III antibodies 
positive 

2 5.26% 

19.10%

52.30%

16.70%

11.9%

Distribution of patients according to age of 
diagnosis

16-35 years 36-55 years 56-65 years over 65 years



 
 
 
 

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Fig. 9. Summary diagram of the different skin manifestations found in our patients 
 

 
 

Fig. 10. Summary diagram of the presence or absence of abnormalities on capillaroscopy 
95.2% of patients had abnormalities in periungual capillaroscopy, 2.4% had a normal capillaroscopy, and 2.4% 

did not undergo the procedure 

 

 
 

Fig. 11.Summary diagram of rodnan score at diagnosis 
57.1% of patients experienced myalgia, and 4.8% had actual myositis 

95.20%

2.40% 2.40%

Abnormalities on capillaroscopy

Yes No Not Done



 
 
 
 

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Fig. 12. Summary diagram of muscle damage 
61.9% of patients experienced inflammatory arthralgia, and 4.8% had true arthritis 

 

 
 

Fig. 13. Summary diagram of joint damage 
19% of patients had osteoporosis, and 4.8% had acro-osteolysis 

 

 
 

Fig. 14. Summary diagram of bone damage 
 
 



 
 
 
 

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Fig. 15. Summary diagram of dyspnea present 
 

 
 

Fig. 16. 6-minute Walk Test result 
. 

 
 

Fig. 17. Summary diagram of thoracic scanner results 
42.9% of patients had diffuse interstitial lung disease on chest CT, 33.3% had a normal scan, 19% had 
pulmonary fibrosis, 2.4% had chronic obstructive pulmonary disease, and 2.4% had a posterior-basal 

parenchymal infiltrate 

9.50%

38.10%
7.10%

1.2

38.10%

Summary diagram of dyspnea 

Stage I Stage II Stage III Stage IV No Dyspnea

33.30%

42.90%

19%

2.40%

Summary diagram of thoracic scanner results

Normal scan Diffuse interstitial lung disease
Pulmonary fibrosis Chronic obstructive pulminory disease
Posterrior basal parenchymal infiltrate



 
 
 
 

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Fig. 18. Summary diagram of the results of the lung functional exploration 
66.6% of patients underwent pulmonary function tests. Among them, 26.2% had inconclusive results, 19% had 

normal results, 19% had a restrictive syndrome, and 2.4% had a mixed ventilatory disorder 

 

 
 

Fig. 19. Summary diagram of cardiac damage 
7.1% of patients had conduction disturbances on EKG, 7.1% had left heart failure, 19% had pulmonary 

hypertension on echocardiography, 2.4% had mitral insufficiency with tricuspid insufficiency and dilation of the 
inferior vena cava, and 7.1% had pulmonary arterial hypertension detected by catheterization 

 

 
 

Fig. 20. Summary diagram of renal damage 
23.8% of patients had hypertension, 11.9% had renal insufficiency, and 2.4% had proteinuria 

26.20%
19%

19%
1.2

Results of the lung functional exploration

Inconclusive results Normal results Restrictive syndrome Mixed ventilatory disorder



 
 
 
 

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Fig. 21. Summary diagram of digestive damage 
50% of patients had gastroesophageal reflux, 21.4% had dyspepsia, 19% had constipation, 11.9% had 
malabsorption, 2.4% had dysphagia with solids, 2.4% had dysphagia with liquid diarrhea, and 2.4% had 

abnormalities on esogastroduodenoscopy. 
 

 
 

Fig. 22. Summary diagram of the different treatments adopted 
 

 
 

Fig. 23. Summary diagram of the different modes of evolution of the pathology in our patients 
47.6% of patients reported progression of the disease, 26.2% had stable disease, 16.7% died, 7.1% reported 

complications, and 2.4% were lost to follow-up 

47.60%

26.20%

7.10% 16.70%

Evolution of the disease

Progression of the disease Stable disease

Complication Death

Lost to follow up



 
 
 
 

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Fig. 24. Summary diagram of the different causes of death 
4 patients died from cardiorespiratory failure, 1 patient died from cardiac arrest due to septic shock, and 2 

patients died from cardiac decompensation 

 
We therefore carried out a retrospective study 
spanning 06 years from January 1, 2018 to 
December 31, 2023 in the Internal Medicine 
department and geriatrics unit of the Ibn Rochd 
University Hospital Center in Casablanca              
during which we highlighted the following 
particularities: 
 

• On the Epidemiological level: 
 

This is a rare condition in our context, of 2164 
patients hospitalized in our department, the 
diagnosis of systemic sclerosis was only retained 
in 42 patients or 1.94%. We noticed a strong 
female predominance with 34 female patients for 
8 male patients, i.e. a sex ratio of 4.25 women for 
1 man, which is consistent with data from the 
French literature [1]. 
 
71.4% of our patients were of urban origin 
compared to 28.6% who were of rural origin, 
dominated by the province of Casablanca from 
which 35.7% originated, followed by the province 
of El Jadida from with 28.6% than the province of 
Settat in 3rd position from which 19% of patients 
came, totaling 83.3% of patients. 
 
Several studies have highlighted the 
physiopathological role of certain organic 
solvents such as aliphatic hydrocarbons, 
halogenated aliphatic hydrocarbons, white spirits 
or naphtha solvents; toluene, xylenes, 
trichloroethylene and aromatic hydrocarbons, 
which made it possible to identify so-called risky 
professions such as car painting, sheet metal 
work and textiles [2]. During our study only 3 

patients, all male, i.e. 7.1% of patients had 
occupations known to be at risk and worked in 
automobile sheet metal, while 71.4% of our 
patients were without a profession and finally 
21.4% had occupations not known to be at risk. 
 
The genetic component has been suggested in 
the bibliography about the pathophysiology of 
systemic scleroderma, evoking some familial 
cases of scleroderma or even an area of familial 
autoimmunity although specific genomic studies 
attempt to precisely identify the genomic actors. 
incriminated are still ongoing. [3,4] We only found 
a family history of systemic sclerosis in 4.8% of 
our patients while a family history of autoimmune 
diseases other than systemic sclerosis was 
found in 14.3% of type patients including 
Systemic Lupus Erythematosus, Rheumatoid 
Arthritis and Immunological Thrombocytopenia. 
 
It has been noted in the French literature that the 
peak frequency of scleroderma is between the 
age of 45 and 64 years [1], but in our study the 
peak frequency was between 36 and 55 years in 
52.3% of our patients, however we noted that the 
onset of symptoms was way before with a delay 
between the appearance of the first symptoms 
and the diagnosis varying between 2 to 5 years 
in 42.9% of patients, greater than 5 years in 
21.4% of patients while it was equal or less than 
to 1 year in 35.9% of patients. 
 

• On the Clinical level: 
 

The first clinical symptoms related to the disease 
were essentially cutaneous (made of Raynaud's 



 
 
 
 

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phenomenon and cutaneous sclerosis found 
respectively in 83.3% and 42.9% of patients), 
joint (type of arthralgia found in 33.7% of 
patients), respiratory (type of Dyspnea found in 
23.8% of patients) and muscular (type of Myalgia 
found in 9.5% of patients). It should be noted that 
patients in whom the pathology first appeared in 
the respiratory system were able to be diagnosed 
quickly in less than a year, while patients with 
joint, muscular and skin involvement could’nt be 
diagnosed quickly with a delay between the 
appearance of symptoms and the making of the 
diagnosis which can exceed 5 years, which can 
be explained by the severity of the condition with 
a rapid manifestation of sufficient classification 
criteria when the pulmonary involvement is 
inaugural, while the diagnostic delay in patients 
showing isolated cutaneous, muscular or joint 
symptoms does not allow the diagnosis to be 
made quickly, especially since patients in the 
Moroccan context only consult late                           
after prolonged and often random self-
medication. 
 
At the time of diagnosis of systemic sclerosis in 
our patients, the clinical picture was dominated 
by skin involvement with Raynaud's 
phenomenon found in 95.2% of patients, 
followed by pulp scars found in 61.9% of 
patients, then curled fingers found in 54.8%, of 
cutaneous sclerosis not exceeding the MCP in 
45.2% and exceeding the MCP in 45.2%, then 
refinement of the lips and nose found in 40.5% of 
patients, then pulpal ulcerations found in 35.7%, 
telangiectasias in 28.6%. The Rodnan scores at 
the time of diagnosis varied between 0 for 
scleroderma sin scleroderma and 40 in patients 
with extensive sclerosis, with a majority Rodnan 
score at 13. Orofacial involvement was present in 
54.8% of patients with limitation of the mouth 
opening in these and calcinosis of the facial in 
only 2 of them. Muscular damage mainly due to 
myalgia was found in 57.1% of patients, only 2 of 
whom presented true myositis with a clinical 
muscle deficit, biological rhabdomyolysis and a 
myogenic trace on the electro-neuro-myogram. 
Joint damage was found in 61.9%, mainly 
suffering from arthralgia, of which only 2 patients 
presented true arthritis. Bone damage was found 
in 23.8% of patients with 2 patients having 
presented acro-osteolysis and 8 having 
presented osteoporosis (a frequent manifestation 
of scleroderma [1]); In a study conducted jointly 
by the Rheumatology Department of Pasteur 
Hospital in Nice and the Nephrology Department 
of CHU Nîmes on 102 patients, the incidence of 
osteoporosis was 35%. In contrast, another study 

conducted at the Internal Medicine Department 
of CHU Tunis in Tunis found an incidence of 
acro-osteolysis at 37.03% [5,6]. 
 

• For visceral damage 
 

Dyspnea was found in 61.9% of patients at 
different stages, with a 6-minute walk test 
returning pathological in 47.6%. Parenchymal 
pulmonary involvement was found in 64.3% of 
patients, respiratory functional exploration found 
a restrictive syndrome in 19% of patients, and 
evaluation of the release of carbon monoxide 
found a decrease in it in 21.4% of patients, none 
of our patients benefited from bronchoscopy with 
bronchoalveolar washing, a controversial 
practice but which has demonstrated its 
effectiveness in early detection [7], other schools 
suggest a histological sampling in order to 
confirm the diagnosis, classify the lung 
involvement and make a prognostic assessment, 
however this practice is still not part of the 
recommendations [8]. Renal damage was found 
in 26.2% of patients, 23.8% presented with 
arterial hypertension, while 11.9% had renal 
failure and 2.4% of patients presented positive 
proteinuria. Cardiac involvement was found in 
23.8% of patients with 7.1% of patients having 
presented abnormalities on the EKG, 7.1% had 
right heart failure, 4.8% had left heart failure, 
19% of patients had Pulmonary hypertension on 
echocardiography and pulmonary arterial 
hypertension was found by catheterization in only 
3 patients (7.1%). It has been reported in the 
literature that severe microcirculation 
abnormalities demonstrated by periungual 
capillaroscopy were strongly associated with 
pulmonary vascular damage [9], but in our study 
capillaroscopy was performed in 41 patients 
(97.6%), and revealed various abnormalities 
ranging from mega capillaries to vascular 
desertification in 95.2% of patients while PH was 
only found in 19% of patients. Digestive 
involvement was found in 54.8% of patients with 
gastroesophageal reflux disease (GERD) in 50% 
of patients, dyspepsia in 21.4%, constipation in 
19%, fluid diarrhea with malabsorption in 2.4% of 
patients and solid dysphagia with endo-brachy-
esophagus on esogastroduodenal fibroscopy. 
Urogenital involvement was found in 33.3% of 
patients, 21.4% of patients presented with 
urinary incontinence, 4.8% with dyspareunia and 
11.9% with erectile dysfunction. 
 
We also observed a reduction in fertility in these 
patients, 100% of patients who had children had 
them before the diagnosis of scleroderma, and 



 
 
 
 

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34.3% of patients attempted unsuccessfully to 
have children after the diagnosis of scleroderma 
all by natural means, we have not found any 
study corroborating this result and we cannot 
exclude the effect of different treatments which 
leaves the question open. 
 

• Therapeutically 
 

For Raynaud's phenomenon, 40 patients were 
placed on calcium channel blockers, 24 of whom 
required the addition of 5 phosphodiestherase 
inhibitors and 8 of whom required the addition of 
fluoxetine. For extensive skin involvement 
without visceral involvement, 17 patients were 
placed on methotrexate, 3 of whom also 
benefited from local treatment with cannabis oil, 
when this was associated with pulmonary 
involvement. 18 patients were placed on 
mycophenolate mofetil, due to lack of average 6 
patients with pulmonary involvement benefited 
from cyclophosphamide and the 3 patients with 
PAH confirmed by catheterization benefited from 
a prostacyclin analog, and only 2 patients 
benefited from Nintedanib-type antifibrosis for 
pulmonary fibrosis. 
 
Despite the therapeutic means made available to 
patients, we remain behind what is done in 
renowned specialized centers and in research 
centers, for skin damage we have demonstrated 
innovation by attempting to add a local treatment 
with Cannabis oil which has demonstrated a 
certain effectiveness in blocking CB2 receptors 
suspected in the pathophysiology of systemic 
sclerosis [10], the use of Hyaluronidase by local 
injection has also demonstrated its effectiveness 
without proof of toxicity and the only negative 
point of which remains the need for multiple 
injections [11] as well as non-pharmacological 
treatments such as sporting and physical activity 
which makes it possible to modulate immunity 
[12] or even ultrasound treatment which makes it 
possible to soften the skin thus making it 
possible to reduce functional limitation [13], with 
regard to the management of Raynaud's 
phenomenon our approach is not far from the 
latest recommendations developed by the 
Rheumatology team of Portugal in this year and 
which revolves around 3 main axes: patient 
awareness against potential triggering factors, 
pharmacological treatment allowing the 
microcirculation to dilate and finally promoting 
the healing of ulcerations before reaching a 
possible amputation [14], a Chinese team carried 
out a literature review in 2021 showing the 
effectiveness of botulinum toxin injection in the 

management of Raynaud's phenomenon [15]. 
Regarding the management of pulmonary 
involvement, the combination of nintedanib, 
mycophenolate mofetil and a low dose of 
corticosteroid therapy has demonstrated their 
superiority to other conventional treatments [16], 
however in our context we remain limited by the 
means and the difficulty of insurance procedures, 
moreover only 2 patients were able to benefit 
from nintedanib. Other studies are underway to 
improve the management of systemic sclerosis, 
such as trials of Janus Kinase inhibitors, TGF 
pathway inhibitors, anti-interleukins 6 and 8 and 
more recently transplantation especially of 
adipose and mesenchymal stem cells and which 
remains the most promising therapy [17,18, 
19,20]. 
 

• Evolution 
 

20 patients reported an improvement (47.6%), 11 
patients (26.3%)  remained stable, 3 patients 
(7.1%) reported various complications, 7 patients 
(16.7%) died while only 1 patient was lost to 
follow-up (2.4%). 
 
The improvement reported by patients concerned 
cutaneous sclerosis in 6 patients, Raynaud's 
phenomenon in 9 patients, lung damage in 8 
patients, digestive damage in 3 patients and joint 
and muscle damage respectively in 4 patients. 
 
Regarding the complications, 13 patients 
presented progression of the pathology, 4 
patients manifested a new autoimmune disease, 
and only 1 patient presented a secondary 
respiratory infection. 
 
For the deceased patients, 3 were aged between 
56 and 62 years at their death, while the other 4 
were over 65 years old at their death. The 
causes of death were dominated by cardiac 
decompensation secondary to pulmonary failure 
in 4 patients, followed by cardiac failure in 2 
patients and 1 patient who had septic shock. 
 

5. CONCLUSION 
 
Systemic sclerosis is an autoimmune disease 
that is certainly rare but bothersome on an 
aesthetic and functional level, and can be life-
threatening due to its various visceral damage 
affecting the lung, heart and kidney. It has an 
unknown cause and a complex and poorly 
understood physiopathological mechanism but is 
increasingly better understood thanks to 
progress made in genetics. The diagnosis is 



 
 
 
 

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based on the ACR/EULAR classification criteria 
based on clinical, biological and radiological 
criteria and the management of which, although 
codified with clear recommendations, is no less 
complicated and costly and always makes the 
object of research with the need for global and 
multidisciplinary care. 
 

In the context of the Casablanca University 
Hospital, although the frequency of the disease is 
relatively low, we find no difficulty in making the 
diagnosis and detecting the various visceral 
disorders, the real challenge remains on the 
therapeutic level which requires a simplification 
of administrative procedures. and easier access 
to different therapeutic molecules. 
 

ANNEXE 
 

Annexe is available in the following link: 
https://journalaji.com/index.php/AJI/libraryFiles/d
ownloadPublic/8 
 

DISCLAIMER (ARTIFICIAL INTELLIGENCE) 
 

Author(s) hereby declare that generative AI 
technologies such as Large Language Models, 
etc have been used during writing or editing of 
manuscripts. This explanation will include the 
name, version, model, and source of the 
generative AI technology and as well as all                  
input prompts provided to the generative AI 
technology 
 

Details of the AI usage are given below: 
 

1. ChatGPT 4 o of Open AI 
2. Used for translating the text from french to 

english 
 

CONSENT 
 

It is not applicable. 
 

ETHICAL APPROVAL 
 

It is not applicable. 
 

COMPETING INTERESTS 
 

Authors have declared that no competing 
interests exist. 
 

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