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The prevalence of difficult airway indices in systemic sclerosis patients and their correlation with the modified Rodnan skin score

Reza Atef Yekta, Hoda Kavosi, Ali Ghasemi, Mahsa Najafi Kandovan, Azin Etemadimanesh, Zahra Tamartash, Ali Javinani, Seyedeh Zahra Fotook Kiaei, Alireza Emamzade, Amirmohammad Mohammadadegan

Introduction: Systemic sclerosis (SSc) is a chronic multisystem autoimmune disease characterized by skin stiffness with pulmonary and cardiovascular involvements, responsible for mortality in SSC patients. Preoperative management in SSc patients is critical to have a better operation result. Owing to possible complications of SSc, prediction of a difficult airway in these patients is fateful for proper airway management. The score of skin stiffness is evaluated by modified Rodnan skin score (MRSS). MRSS measures skin stiffness and has been widely utilized to assess the progression and severity of the disease. In this study, we aimed to investigate the prevalence of the difficult airway indices (DAIs) in SSc patients and evaluate the correlation between the DAIs and the MRSS.

Material and method: A total of 139 patients with a definite diagnosis of SSc based on the ACR/EULAR 2013 criteria were enrolled in this cross-sectional study. The DAIs included the modified Mallampati classification (MMC), 3-3-2 rule, mouth opening (MO), thyromental distance, finger to palm (FTP), upper lip bite test (ULBT), and prayer sign was measured in addition to MRSS.

Results: The median MRSS was 14. The most frequent DAIs among the patients was MMC (37.5%) and prayer sign (35.2%). The MRSS was significantly correlated with the 3-3-2 rule, MO, FTP, ULBT, and prayer sign. No significant correlation was seen between the disease duration and the recorded variables. Conclusion: In this study, we found that the MRSS is associated with DAIs making it a valuable asset in the preoperative evaluations of SSc patients.