The preliminary set of research questions concerning SSc treatment was provided by 74 EUSTAR centres. After a process of aggregation and data reduction by a modified Delphi technique Prada Bags Replica, the experts selected the final set of 26 questions for the systematic literature research. Retrieved clinical trial publications were evaluated using the Jadad classification,4 and the level of evidence was graded from Ia to IV.5 Outcome data for efficacy and adverse events were abstracted and effect size (ES), number needed to treat (NNT) and number needed to harm were calculated when appropriate.RESULTSEvidence based approachOut of 5421 publications identified Prada Outlet, 281 were included in the final analysis.The methodology, including the selection of research questions and literature search strategy and the results of systematic literature research are presented separately.3Experts’ opinion approachThe final set of recommendations, grouped according to organ systems and the future research agenda are summarised in table 1 and box 1, respectively.View this table:View inlineView popupTable 1 The final set of 14 recommendations based on both evidence from the literature and expert opinionThe evidence that there are few high quality trials in SSc prompted the experts also to include information concerning the highest level of evidence based upon which a particular recommendation was formulated.Moreover, the experts decided to formulate, in addition to the main recommendations Prada Replica, several comments concerning medications or therapies addressed in research questions, on which at present neither literature based evidence nor clinical experience allowed precise recommendations to be made, see table 2.View this table:View inlineView popupTable 2 Comments of the expert committee concerning research questions that did not yield a formal recommendation because of lack of appropriate evidenceOne meta analysis, including eight randomised controlled trials (RCT; seven with nifedipine and one with nicardipine)6 13 with 109 SSc patients involved, indicates that dihydropiridine type calcium antagonists reduce the frequency and severity of ischaemic attacks in SSc RP.14 The weighted mean difference (WMD) of all calcium antagonists versus placebo (six trials) for the reduction in the number of ischaemic attacks over a 2 week period was 8.3 (95% CI 0.9 to 15.7).

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