Background/Purpose: The vascular hypothesis in systemic sclerosis (SSc) posits that vasculopathy is the initial inciting event that triggers inflammation and subsequent fibrosis in the progression of the disease. The primary objective of this study was to evaluate the association of serum MHR with skin manifestations, including Raynaud’s phenomenon (assessed via the Raynaud’s Condition Score), digital ulcers (measured by the Digital Ulcer Score), and skin fibrosis (evaluated using the Modified Rodnan Skin Score) in patients with SSc. The secondary objectives included assessing choroidal subfoveal thickness in SSc patients and investigating the associations between choroidal thickness, MHR, and skin manifestations.

Methods: After obtaining approval from the Institutional Ethics Committee (IEC), this case-control study was conducted at ESIC Medical College and Hospital in Telangana, India. A total of 35 adult patients with systemic sclerosis and 35 age- and gender-matched healthy controls were recruited, all of whom met the inclusion criteria. Serum monocyte-to-HDL cholesterol ratio (MHR) was calculated and compared between the two groups. High-definition optical coherence tomography (HD-OCT) was used to measure choroidal subfoveal thickness, and these measurements were also compared between the groups. Correlations between serum MHR values, choroidal subfoveal thickness and skin manifestations among systemic sclerosis patients were analyzed. Statistical analysis was performed using SPSS Version 21, with significance set at p< 0.05.

Results: In our study, both groups consisted of 35 individuals, with 30 females in each group. The mean age was 37.6 years in systemic sclerosis patients and 38.9 years in healthy controls. The mean MHR was significantly higher in patients with systemic sclerosis compared to healthy controls (p< 0.05). Choroidal subfoveal thickness was significantly lower in patients than in controls (p< 0.05).While MHR values showed a positive correlation with markers of peripheral microvascular involvement—such as the Raynaud's Condition Score (RCS), Digital Ulcer Score (DUS), and skin fibrosis assessed by the Modified Rodnan Skin Score (MRSS)—statistical significance was not achieved. Choroidal subfoveal thickness exhibited a negative correlation with all skin parameters asessed.

Conclusion: The findings from this study support the use of non-invasive techniques, such as high-definition optical coherence tomography (HD-OCT), for evaluating choroidal microvasculature in patients with systemic sclerosis, even at early stages of the disease. Additionally, the study suggests that the monocyte-to-HDL cholesterol ratio (MHR) may serve as a simple, cost- effective, and easily measurable serum biomarker. MHR could help identify SSc patients at higher risk for vasculopathy, including digital ulcers and more advanced skin fibrosis.As an indirect marker of oxidative stress and inflammation, MHR showed a correlation with changes in choroidal microvasculature. Therefore, combining MHR with choroidal vascular evaluation provides valuable adjunctive diagnostic support for assessing overall microcirculation in patients with systemic sclerosis.

Comparison of Monocyte-to-HDL Ratio Between Systemic Sclerosis Patients and Healthy Controls

Comparison of Choroidal Sub-foveal Thickness using HD-OCT Between Systemic Sclerosis Patients and Healthy Controls

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-choroidal-sub-foveal-thickness-with-skin-manifestations-and-serum-monocyte-hdl-ratio-in-patients-with-systemic-sclerosis-a-case-control-study/