Efficacy of Tofacitinib on Skin Thickening in Diffuse Cutaneous Systemic Sclerosis: A Comparative Study With Methotrexate

Inclusion Criteria: * 1\. Diagnosed with systemic sclerosis (SSc) according to the 2013 ACR/EULAR classification criteria 2. Classified as having diffuse cutaneous systemic sclerosis (dcSSc), as defined by LeRoy and Medsger 3. Disease duration of ≤ 36 months, calculated from the onset of the first non-Raynaud's phenomenon manifestation. 4\. Modified Rodnan Skin Score (mRSS) between 10 and 45 at the time of screening. 5\. Concurrent use of calcium channel blockers and phosphodiesterase-5 inhibitors for the treatment of Raynaud's phenomenon or digital ulcers was permitted. 6\. Subjects were aged 18 years and older Exclusion Criteria: * 1\. Presence of a rheumatic disease other than systemic sclerosis, except for fibromyalgia or scleroderma-associated myopathy. 2\. Evidence of any active infection, including active tuberculosis 3. Abnormal laboratory values at screening, including: * Hemoglobin \<9 g/dL * White blood cell count \<3.0 × 10⁹/L * Absolute neutrophil count \<1.2 × 10⁹/L * Platelet count \<100 × 10⁹/L * Absolute lymphocyte count \<0.75 × 10⁹/L * ALT or AST \>3× the upper limit of normal (ULN) * Estimated glomerular filtration rate (eGFR) \<60 mL/min/1.73 m² 4\. Pulmonary function showing forced vital capacity (FVC) ≤ 50% predicted, or DLCO (uncorrected for hemoglobin) ≤ 40% predicted. 5\. History of major surgery (including joint surgery) within 8 weeks prior to the screening visit. 6\. Use of oral corticosteroids 7. Diagno…