What would be your recommendation for treatment of worsening lung disease in a patient with long-standing scleroderma after long-term mycophenolate therapy which is no longer an option due to side effect/intolerance?  

Someone who has been on long-term Mycophenolate for interstitial lung disease and has had stabilization or improvement in their lung function and then is unable to tolerate the medication may be able to be switched to mycophenolic acid sodium (myfortic) which is often less toxic and better able to b...

In the setting of progressive disease despite mycophenolate and Rituximab, you can also try monthly IVIG.

I am not very experienced (apart from considering Ofev) but some of our Rheumatologists have tried Azathioprine or Methotrexate in those rare cases. I would love to know the opinions of others.