Update of EULAR recommendations for the treatment of systemic sclerosis

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Otylia Kowal-Bielecka
  • Jaap Fransen
  • Jerome Avouac
  • Mike Becker
  • Agnieszka Kulak
  • Yannick Allanore
  • Oliver Distler
  • Philip J. Clements
  • Maurizio Cutolo
  • Czirják László
  • Nemanja Damjanov
  • Francesco Del Galdo
  • Christopher P. Denton
  • Jörg H.W. Distler
  • Ivan Foeldvari
  • Figelstone Kim
  • Marc Frerix
  • Daniel E Furst
  • Serena Guiducci
  • Nicolas Hunzelmann
  • Dinesh Khanna
  • Marco Matucci-Cerinic
  • Frank Van Den Hoogen
  • Jacob M. van Laar
  • Gabriela Riemekasten
  • Richard Silver
  • Vanessa Smith
  • Alberto Sulli
  • Ingo Tarner
  • Alan Tyndall
  • Joep Welling
  • Frederick M. Wigley
  • Gabriele Valentini
  • Ulrich A Walker
  • Francesco Zulian
  • Ulf Müller-Ladner


Objectives: The aim was to update the 2009 EULAR recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions.
Methods: Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and USA, two patients nominated by the pan-European patient association for SSc (FESCA), a clinical epidemiologist and 2 research fellows. All centers from the EULAR Scleroderma Trials and Research (EUSTAR) group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients.
Results: The procedure resulted in sixteen recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud’s phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis, and gastrointestinal involvement. Compared with the 2009 recommendations, the 2015 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues, and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressing SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated.
Conclusions: These updated data- and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.

Bibliographical metadata

Original languageEnglish
JournalAnnals of the rheumatic diseases
Early online date9 Nov 2016
Publication statusPublished - 2017