j.m.van-laar{at}ncl.ac.uk Jacob M. van Laar

I read with interest the article by Smith et al, which provides encouraging data on safety and potential efficacy of rituximab in a subset of patients with diffuse cutaneous systemic sclerosis (DcSSc). It lends support to the concept that B-cell depletion could be a relatively safe and effective strategy DcSSc. The effects on skin thickening differ from those published by Lafyatis et al, indicating a prospective,controlled,randomised trial is urgently needed.
There is currently no gold standard measure of disease activity in SSc, which would facilitate clinical trials. The authors refer to a disease activity score in Table 1B, it would be helpful if they explain what score they have used (including a reference).