Screening and management of systemic sclerosis-associated pulmonary complications in Iraq: insights from a national survey of rheumatologists and pulmonologists.

Introduction: This study evaluated the screening and management approaches of Iraqi rheumatologists and pulmonologists regarding systemic sclerosis interstitial lung disease (SSc-ILD) and pulmonary hypertension (PHT), identifying key gaps and areas for improvement. Material and methods: An internet-based survey was distributed to Iraqi rheumatologists and pulmonologists from August to October 2024. The survey collected demographic data, screening methods, treatment initiation criteria, and therapeutic preferences. Descriptive statistics were used to analyse the responses, and trends were identified on the basis of physician speciality and experience level. Results: A total of 116 participants responded (75.9% rheumatologists, 24.1% pulmonologists). Routine screening for ILD was reported by 88.8% of respondents, with 62.1% screening at diagnosis. High-resolution computed tomography (HRCT) was the preferred screening tool (61.7%), followed by pulmonary function tests (52.2%). However, only 31% of patients are routinely screened for PHT, with most relying on unexplained dyspnoea or annual assessments. Mycophenolate mofetil was the preferred first-line treatment for SSc-ILD (87.5%), whereas rituximab and azathioprine were less commonly used. Treatment decisions were guided primarily by HRCT findings and pulmonary function trends. Despite 89.3% reporting multidisciplinary collaboration, variability in screening and treatment approaches suggests inconsistencies in guideline adherence. Conclusions: This study revealed inconsistencies in the screening and management of SSc-ILD and PHT among Iraqi specialists. While ILD screening is commonly performed via HRCT, PHT screening remains suboptimal. Mycophenolate mofetil is the preferred treatment, but adherence to international guidelines varies. Strengthening standardised protocols and multidisciplinary collaboration is essential to improve patient care. Future research should prioritise the identification of barriers to the effective implementation of clinical guidelines and the evaluation of the effects of standardised care practices on patient outcomes.