Conflicts of interest: R. Lafyatis reports support for the present manuscript from NIH, grants from Bristol Meyer Squib, Formation, Moderna, Regeneron and Pfizer, consultancy with Abbvie, Mediar, Bristol Meyers Squibb, Formation, Thirona Bio, Sanofi, Boehringer-Ingelheim, Merck, Genentech/Roche, EMD Serono, Morphic, Third Rock Ventures, Bain Capital and Zag Bio, sitting on an independent data safety monitoring committees for Advarra/GSK and Genentech, payment or honoraria for lectures, presentations, manuscript writing or educational events from American College of Rheumatology, and support for attending meetings from Abbvie; R. Lafyatis holds stock in Thirona Bio Inc and is president and holds stock in Modumac Therapeutics Inc. E. Valenzi reports grant support from NIH/NHLBI and Boehringer Ingelheim, and reports travel support from National Scleroderma Foundation.