How do you utilize methotrexate and/or hydroxychloroquine in the setting of limited scleroderma/CREST?

Thank you for this great question!

The use of immune-suppression in systemic sclerosis is generally reserved for progressing skin sclerosis, progressive ILD, inflammatory arthritis, inflammatory myositis, and myocarditis. These manifestations have a significantly higher prevalence in diffuse cutaneous SSc, especially in early dcSSc (i.e., lesser than 18 months up to 3 years), and thus medications like Methotrexate have the greatest utilization in this subset of SSc patients.

With that said, methotrexate and/or hydroxychloroquine can be helpful in inflammatory arthritis in patients with both limited and diffuse cutaneous SSc. In patients with predominant skin involvement that is progressive, I favor mycophenolate mofetil but it has little effi...