In the absence of lung disease, do you prefer methotrexate or mycophenolate mofetil in the initial treatment of cutaneous-only manifestations in systemic sclerosis?  

I typically will use mycophenolate if I think the patient needs "skin only" treatment. This recommendation is based on my personal experience, retrospective and observational data, and data that can be gained from other clinical trials (SLS2 for example). If the patient has prominent joint disease, ...

I agree with Dr. Hummers. Actemra may be helpful for early mild to moderate ILD but it was not helpful for skin. Pol 3 patients tend to have more severe skin that often improves faster than Scl 70 patients but their ILD tends to be less aggressive than in Scl 70 patients, so for Pol 3 patients unles...