Given the importance of IL-6 in SSc (O’Reilly et al., 2012, 2013), with significantly elevated levels in the blood and tissues (Hasegawa et al., 1999), a downstream target of IL-6 such as Gremlin-1 may be a more realistic target in this disease as the importance of IL-6 in normal immune functions is critical. This evidence concerns the gene GREM1 and systemic sclerosis.