Distler, O.

Matucci-Cerinic, M.

Müller-Ladner, U.

Seibold, J. R.

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A path to the future in sclerodermaIn October of 2007, a group of true experts in diverse areasrelevant to scleroderma were invited to Florence, Italy for a 2-daysymposium on ‘Controversies in Scleroderma’. As the organizingcommittee for this activity, we selected the topics and speakersand the format of the meeting which focused on brief cutting-edgepresentations followed by intensive group discussions.This Supplement to Rheumatology seemed inescapably impor-tant to realize as a summary of the conference and as acompendium for the student of scleroderma everywhere. Eachauthor was asked to write a concise treatise on their individualarea of expertise and to follow a uniform format for under-standability and accessibility.Full answers are not yet in to critically important questionsin scleroderma but progress is considerable. We work in an eraof excitement, collaboration and anticipation. The biologicalplatform for considering interventions has never been stronger.We have several plausible molecular targets and the intellectualframework via which we can stratify our approach. As our under-standing of the vascular, immunological and fibrotic features ofdisease evolves, new hypotheses will emerge and hopefully beefficiently and appropriately tested in controlled clinical trials.However, these trials will not be robust unless there is progress inthe clinical sciences of trial design and outcome measures.Scleroderma is a remarkably heterogeneous disorder. It is likelythat progress in therapy will be focused on both specific featuresof disease and on overarching approaches to the commonalities ofdisease pathogenesis that are expressed in all patients. Lungdisease remains the leading cause of death with parenchymal andvascular pathologies being of near equal importance. Thisconference paid particular attention to new knowledge in bothareas that will permit efficient study of well-documented cohortsof clinically and pathophysiologically similar patients.There is a lot here but also a lot of work ahead! We have betterscience and a sophisticated approach to clinical management andtrial design. Effective treatments seem within reach.AcknowledgementsSupplement: This paper forms part of the supplement entitled‘Update in systemic sclerosis’. This supplement was supported byan unrestricted grant from Encysive.Disclosure statement: J.R.S. has funded research and/or con-sultancy relationships with Actelion, Pfizer, Gilead, Encysive,Pipex, Centocor, Celgene and United Therapeutics relevant toscleroderma therapy. M.M.-C. has a consultancy relationshipwith Actelion relevant to digital ulcers. O.D. has receivedresearch grants and/or served as a consultant for Encysive,Actelion, Ergonex and Array Biopharam. U.M.-L. is sup-ported by the EULAR scleroderma trials and research group(EUSTAR) and the Deutsches Netzwerk fuer SystemischeSklerose (DNSS).O. DISTLER1, M. MATUCCI-CERINIC2, U. MU¨LLER-LADNER3,4,J. R. SEIBOLD51Department of Rheumatology, Center for ExperimentalRheumatology, University Hospital Zurich, Zurich, Switzerland,2Department of Biomedicine, Division of Rheumatology, AOUC,Denothe Center, University of Florence, Florence, Italy,3Department for Internal Medicine and Rheumatology, Justus-Liebig University Giessen, 4Department for Rheumatology andClinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germanyand 5University of Michigan Scleroderma Program, Ann Arbor,MI, USAAccepted 24 July 2008Correspondence to: J. R. Seibold, University of MichiganScleroderma Program, 24 Frank Lloyd Wright Drive, POBox 481, Lobby M, Suite 2500, Ann Arbor, MI, USA 48106.E-mail: jseibold@umich.eduRheumatology 2008;47:v1 doi:10.1093/rheumatology/ken351v1 The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A path to the future in scleroderma

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