Novel Diagnostic and Therapeutic Perspectives in Systemic Sclerosis

Dear Colleagues,

Early diagnosis and treatment of systemic sclerosis are advancing through a mechanistic understanding of vasculopathy, immune dysregulation, and fibrosis. Diagnostic improvements include VEDOSS criteria, autoantibody biomarkers, advanced imaging, and nailfold capillaroscopy for early detection. Targeted therapies, such as mycophenolate mofetil, nintedanib, tocilizumab, and rituximab, are emerging, with autologous stem cell transplantation being considered for select patients.

Personalized, biomarker-driven therapies targeting immune, vascular, and fibrotic pathways are under development. CD19 CAR-T cell therapy, bsAbs, and novel agents targeting interferon pathways, BAFF, FcRn, and pro-fibrotic signaling represent a shift towards precision medicine and immune reprogramming. These are promising for patients with early diffuse disease or refractory complications.

Early intervention and cross-organ treatment strategies offer potential for disease modification beyond symptom management. The critical goal is validating early biomarkers of disease trajectory and incorporating them into treatment algorithms to enable personalized and preventive strategies. This necessitates adaptive, mechanism-based trial designs to accelerate the implementation of novel therapies.

Dr. Mislav Radić
Guest Editor

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