In a recent study evaluating different ACA isotypes in very early SSc (i.e., patients with ACA-IgG, Raynaud's phenomenon, and/or puffy fingers and/or abnormal nailfold capillaroscopy, but not fulfilling the ACR/EULAR 2013 criteria for SSc) and definite SSc patients, ACA-IgG and ACA-IgM levels were found significantly higher in patients with definite SSc, with progression to established disease being associated with higher IgG isotype at baseline [11]. Here, CD40LG is linked to systemic sclerosis.