Modern treatment of systemic sclerosis: review of 2023-2024 guidelines

Abstract

Background. Systemic sclerosis is a chronic autoimmune disease-causing fibrosis, vascular damage, and immune dysfunction. New treatments like immunosuppressants, biologics, and antifibrotics improve outcomes. Early diagnosis and personalized therapy are key to managing organ involvement and progression. Objective(s). The objective(s) of this study is to present a comprehensive review of the latest treatment options for systemic sclerosis, focusing on therapies recommended in 2023–2024 international guidelines. Materials and methods. We analyzed 2023–2024 guidelines and clinical trials on systemic sclerosis treatments, focusing on immunosuppressants, biologics, antifibrotics, and stem cell transplantation in various disease stages. Studies analyze the efficacy and safety of nintedanib, tocilizumab, and autologous hematopoietic stem cell transplantation were included. Results. Recent studies show mycophenolate mofetil and cyclophosphamide reduce skin and lung fibrosis. Tocilizumab and rituximab improve immune modulation. Nintedanib slows lung decline in SSc-ILD. Stem cell transplantation benefits severe cases. Personalized therapy based on disease subtype and severity improves outcomes. Side effects vary but are manageable. Early treatment initiation is associated with better prognosis and quality of life. Ongoing trials explore novel targets for fibrosis and immune pathways. Comprehensive care protocols include smoking cessation, vaccination updates, pulmonary rehabilitation and nutritional optimization. Conclusion(s). Modern treatment of systemic sclerosis focuses on targeted immunosuppression and antifibrotic therapy. Moving forward, research should focus on direct comparisons of combination therapies, optimized sequencing of agents, long-term safety, and biomarker-guided treatment pathways.