[Progress in Systemic Sclerosis - Early, Targeted and Intensive Therapy is the Key to Success]

This literature review summarizes the main findings in systemic sclerosis (SSc) made in the last few years. Accordingly, the disease pathogenesis is mainly driven by the adaptive immune system, which is proven by the effects of autologous stem cell transplantation. Particularly, autoantibodies can activate both adaptive as well as innate immune cells as identified for the anti-angiotensin receptor antibodies. In addition, major achievements come from the early recognition of organ complications, which mainly appear in the first years upon Raynaud`s phenomenon. This implicates screening for organ complications such as for pulmonary arterial hypertension (PAH) or interstitial lung disease (ILD) even without any clinical symptoms at the beginning. On the other hand, the presence of anti-polymerase III antibodies indicates a risk or the presence of malignant diseases, which should be identified. Several studies in the last years showed the high burden of the disease, which is often underscored by physicians. Pain, depressions, fatigue, and incontinence often determine quality of life and should be recognized and treated, if possible. Systemic sclerosis is a disease with the highest disease-related mortality among the rheumatic diseases. More than half of the SSc patients die from SSc manifestations particularly from cardiac and lung involvement such as PAH and ILD. Ventricular tachycardias should be recognized by Holter-ECG. Finally, intensive therapies such as autologous stem cell transplantation or combination therapies seem to be most successful in SSc as well as in SSc-related PAH. Currently, several studies are ongoing, which will hopefully change the outcome and quality of life.