Systemic sclerosis - A vascular perspective

Although recognized clinically and histological for many decades, the macro- and microvascular lesions of systemic sclerosis (SSc) are poorly understood etiopathogenetically. This review attempts to describe and characterize SSc from the vascular perspective with emphasis on the evidence and possible mechanisms of endothelial activation and injury. Similarities between SSc vascular lesions and homograft rejection, as well as graft-versus-host reactions, are used to project immune and autoimmune hypotheses amenable to future study. SSc could well engage several more generations of young investigators before its secrets are fully disclosed.