Guide from the Colegio Mexicano de Reumatología for the Pharmacological Treatment of Systemic Sclerosis Part 1: Cutaneous Involvement, Interstitial Lung Disease, and Pulmonary Arterial Hypertension

Systemic sclerosis (SSc) is a severe autoimmune disease characterized by fibrosis, inflammation, and vasculopathy, with high morbidity and mortality. Cutaneous involvement is an important marker of disease severity, while interstitial lung disease and pulmonary arterial hypertension represent the leading causes of death. This manuscript presents the first national pharmacologic treatment guideline, developed using the GRADE methodology and structured around a flexible, stepwise therapeutic algorithm. Unlike international guidelines, this proposal prioritizes clinical applicability and context-specific decision-making, given the heterogeneity of resources and access to treatments within our healthcare system. The guideline was developed by a multidisciplinary panel including rheumatologists, dermatologists, pulmonologists, cardiopulmonologists, and methodologists. Authors formulated ten PICO questions, and a systematic search was conducted in PubMed, Cochrane Library, EMBASE, and LILACS (2006-February 2024), including key earlier literature. Of 594 records identified, 114 studies were ultimately included after evaluation using the GRADE methodology. Steroids, immunosuppressants, immunomodulators, hematopoietic stem cell transplantation, and vasodilators were assessed. A total of 26 recommendations were issued and subjected to Delphi consensus, with agreement defined as ≥80% acceptance.

Published by Reumatologia clinica, 2026. The guideline itself is at the source linked here.

doi.org/10.1016/j.reumae.2026.502164