Treatment of Skin Fibrosis in Early Inflammatory Diffuse Cutaneous Systemic Sclerosis
In the early, inflammatory phase of diffuse cutaneous systemic sclerosis (dcSSc), skin fibrosis is a defining and clinically significant feature. This protocol addresses first-line management of that specific presentation.
Clinical Scenario
Skin fibrosis occurring in the setting of early, inflammatory diffuse cutaneous systemic sclerosis — a phase characterised by active immune-mediated cutaneous involvement requiring prompt, targeted management.
Treatment Approach (Partial Overview)
Current evidence supports immunosuppressive therapy in this setting, with agents such as methotrexate among those considered. Additional options and the full evidence-based regimen — including selection criteria and sequencing — are detailed in the complete protocol.
Clinical Goal
The primary treatment target is improvement in the modified Rodnan skin score (mRSS), a validated measure of the extent of skin thickness and fibrosis.
References
DOI: 10.1136/ard-2024-226430
- Tocilizumab may be considered for the treatment of skin fibrosis in patients with early, inflammatory dcSSc.
- Methotrexate (1B), mycophenolate mofetil (MMF) (1B) and/or rituximab (1A) should be considered for treatment of SSc skin fibrosis.
- Patients received four intravenous doses of the assigned intervention (rituximab 375 mg/m2 or placebo; once per week for 4 weeks).
- The absolute improvement in mRSS at 24 weeks was significantly higher in the rituximab group than in the placebo group.