Pitt Pediatrics congratulates Kathryn Torok, MD, and Kaila L. Schollaert-Fitch, MS, for their recent publication in the Journal of Investigative Dermatology. Both Torok and Schollaert-Fitch are part of the Division of Rheumatology. Their joint publication, which includes collaborators from the University of Texas Southwestern Medical Center, is titled, “Clinical Characteristics Associated with Musculoskeletal Extracutaneous Manifestations in Pediatric and Adult Morphea: A Prospective, Cohort Study.” 
This research is specifically focused on Morphea and its related effects on pediatric and adult populations. Morphea, generally speaking, is an autoimmune condition of the skin that can cause hardening and discoloration, and is associated with functional sequelae resulting from musculoskeletal involvement. The problem is that research into risk for musculoskeletal involvement is limited, especially in adults. This knowledge gap, for both adults and children, contributes to sometimes insufficient patient care as practitioners are unable to properly risk stratify patients.
In order to address this issue, Torok, Schollaert-Fitch, and their collaborators analyzed over 1,000 participants to determine the frequency, distribution, and type of musculoskeletal (MSK) extracutaneous manifestations affecting joint and bone with overlying morphea lesions. And results demonstrated just under a third of children (32%) and 21% of adults experienced MSK extracutaneous manifestations. Interestingly, children demonstrated limited range of motion in larger joints, such as knees and shoulders, while adults more commonly suffered in small joints, such as toes or jaw.
Further models revealed that deep tissue involvement in patients is strongly correlated with MSK features and the predictive value of MSK extracutaneous manifestations, implying a need for clinicians to look more closely at depth of involvement, in addition to anatomic distribution, to accurately risk stratify patients.
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