Thank you for agreeing to participate in this survey, which aims to assess your level of agreement with the 2023 updated EULAR recommendations for the treatment of systemic sclerosis.

This survey is divided into two parts:
- In the first part, you will be asked about your professional characteristics (specialty, continent of practice, etc.).
- In the second part, you will be asked to rate your level of agreement with each of the recommendations from the 2023 update.

The survey will take approximately 15 minutes to complete.
PART I : your professional characteristics

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1. What is your main specialty? (Required.)

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2. In which continent do you practice? (Required.)

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3. Is your institution a EUSTAR center? (Required.)

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4. Are you a member of any other scleroderma networks? (Required.)

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5. If yes, please specify

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6. How many years of clinical experience do you have in systemic sclerosis? (Required.)

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7. How many patients with systemic sclerosis do you personally see per month? (Required.)

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8. How many patients with systemic sclerosis are seen annually in your center? (Required.)

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9. Are you participating in clinical trials for systemic sclerosis? (Required.)

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10. Have you ever participated in drafting recommendations on systemic sclerosis? If so, which ones? (Required.)

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11. Are you familiar with the 2023 update of the EULAR recommendations for the treatment of systemic sclerosis? (Required.)

PART II : your level of agreement with each of the recommendations from the 2023 updated EULAR recommendations for the treatment of systemic sclerosis.
For all of the following questions referring to a recommendation from the 2023 update of the EULAR recommendations for the treatment of systemic sclerosis, please rate how closely you follow each recommendation in your daily practice on a scale from 0 to 10 (0 = never follow this recommendation; 10 = always follow this recommendation).

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12. Dihydropyridine-type calcium antagonists, usually oral nifedipine, should be used as first-line therapy for SSc-RP. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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13. Have you ever prescribed Dihydropyridine-type calcium antagonist as first-line therapy for RP in a patient with systemic sclerosis? (Required.)

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14. PDE5 inhibitors should also be considered for treatment of SSc-RP. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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15. Have you ever prescribed PDE5 inhibitors for the treatment of RP in a patient with systemic sclerosis? (Required.)

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16. Intravenous iloprost should be considered for severe SSc-RP following failure of oral therapy. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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17. Is intravenous iloprost available in your country? (Required.)

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18. Have you ever prescribed Intravenous iloprost for severe RP, following failure of oral therapy, in a patient with systemic sclerosis? (Required.)

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19. PDE5 inhibitors and/or intravenous iloprost should be considered for the treatment of digital ulcers in patients with SSc. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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20. Have you ever prescribed PDE5 inhibitors and/or intravenous iloprost for the treatment of digital ulcers in a patient with systemic sclerosis? (Required.)

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21. Bosentan should be considered for reduction of number of new digital ulcers in SSc. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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22. Is Bosentan available in your country? (Required.)

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23. Have you ever prescribed Bosentan for reduction of number of new digital ulcers in a patient with systemic sclerosis? (Required.)

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24. Combination of PDE5i and endothelin receptor antagonists should be considered as first-line treatment of SSc PAH. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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25. Have you ever prescribed this combination of PDE5i and endothelin receptor antagonists for first-line treatment of PAH in a patient with systemic sclerosis? (Required.)

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26. Intravenous epoprostenol should be considered for the treatment of SSc patients with advanced PAH (class III and IV). (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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27. Is Intravenous epoprostenol available in your country? (Required.)

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28. Have you ever prescribed Intravenous epoprostenol for the treatment of advanced PAH in a patient with systemic sclerosis? (Required.)

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29. Other prostacyclin analogues or agonists should be considered for the treatment of SSc PAH. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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30. Are any other prostacyclin analogues or agonists available in your country? (Required.)

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31. Have you ever prescribed other prostacyclin analogues or agonists for the treatment of PAH in a patient with systemic sclerosis? (Required.)

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32. Riociguat can be considered for treatment of SSc PAH. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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33. Is Riociguat available in your country? (Required.)

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34. Have you ever prescribed Riociguat for the treatment of PAH in a patient with systemic sclerosis? (Required.)

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35. The use of anticoagulants (warfarin) for the treatment of SSc-PAH is not recommended. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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36. Have you ever prescribed anticoagulants for the treatment of SSc-PAH despite this negative recommendation? (Required.)

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37. ACE inhibitors should be used immediately at diagnosis of scleroderma renal crisis. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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38. Have you ever prescribed ACE inhibitors at diagnosis of renal crisis in a patient with systemic sclerosis? (Required.)

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39. SSc patients treated with glucocorticoids should have regular monitoring of blood pressure to detect scleroderma renal crisis. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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40. PPI should be considered for the treatment of SSc-GERD and prevention of oesophageal ulcers and strictures. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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41. Have you ever prescribed PPI for the treatment of SSc-GERD and prevention of oesophageal ulcers and strictures in a patient with systemic sclerosis? (Required.)

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42. The use of prokinetic drugs should be considered for the treatment of symptomatic motility disturbances related to SSc. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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43. Have you ever prescribed prokinetic drugs for the treatment of symptomatic motility disturbances related to SSc? (Required.)

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44. The use of rotating antibiotics should be considered for the treatment of small intestinal bacterial overgrowth. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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45. Have you ever prescribed rotating antibiotics for the treatment of small intestinal bacterial overgrowth in a patient with systemic sclerosis? (Required.)

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46. Methotrexate (1B), mycophenolate mofetil (MMF) (1B) and/or rituximab (1A) should be considered for treatment of SSc skin fibrosis. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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47. Is Methotrexate available in your country? (Required.)

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48. Have you ever prescribed Methotrexate for the treatment of SSc skin fibrosis in a patient with systemic sclerosis? (Required.)

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49. Is mycophenolate mofetil available in your country? (Required.)

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50. Have you ever prescribed mycophenolate mofetil for the treatment of skin fibrosis in a patient with systemic sclerosis? (Required.)

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51. Is rituximab available in your country? (Required.)

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52. Have you ever prescribed rituximab for the treatment of skin fibrosis in a patient with systemic sclerosis? (Required.)

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53. Tocilizumab may be considered for the treatment of skin fibrosis in patients with early, inflammatory dcSSc. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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54. Is Tocilizumab available in your country? (Required.)

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55. Have you ever prescribed Tocilizumab for the treatment of skin fibrosis in patients with early, inflammatory dcSSc? (Required.)

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56. MMF (1A), cyclophosphamide (1A) or rituximab (1A) should be considered for the treatment of SSc-ILD. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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57. Is cyclophosphamide available in your country? (Required.)

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58. Have you ever prescribed cyclophosphamide for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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59. Have you ever prescribed MMF for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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60. Have you ever prescribed rituximab for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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61. Nintedanib should be considered alone or in combination with MMF for the treatment of SSc-ILD. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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62. Is Nintedanib available in your country? (Required.)

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63. Have you ever prescribed Nintedanib alone for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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64. Have you ever prescribed Nintedanib in combination with MMF for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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65. Tocilizumab should be considered for the treatment of SSc-ILD. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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66. Have you ever prescribed Tocilizumab for the treatment of ILD in a patient with systemic sclerosis? (Required.)

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67. High-intensity immunosuppression (usually including cyclophosphamide) followed by autologous HSCT may be considered for the treatment of selected patients with early dcSSc and poor prognosis, in the absence of advanced cardiorespiratory involvement. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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68. Is autologous HSCT available in your country? (Required.)

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69. Is autologous HSCT available in your center? (Required.)

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70. Have you ever prescribed autologous HSCT for the treatment of patients with early dcSSc and poor prognosis? (Required.)

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71. Methotrexate should be considered for the treatment of musculoskeletal involvement in SSc. (0 = never follow this recommendation; 10 = always follow this recommendation) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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72. Have you ever prescribed Methotrexate for the treatment of musculoskeletal involvement in a patient with systemic sclerosis? (Required.)

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73. Overall, how closely do you follow the 2023 EULAR recommendations for the treatment of systemic sclerosis (SSc)? (0 = never follow these recommendations in any domain; 10 = always follow these recommendations in all domains) (Required.)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.
Thank you for your response. Your contribution is essential for evaluating adherence to the EULAR recommendations for systemic sclerosis and will help inform future improvements in patient care and clinical guidelines.

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