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Systemic sclerosis (SSc) is a heterogeneous autoimmune disease, where a significant proportion of patients develop interstitial lung disease (ILD), which is the major cause of mortality. In recent years, the diagnosis of SSc-ILD has improved a lot, and caring rheumatologists, together with pulmonologists, regularly screen and follow the development and course of ILD. Considerable progress has also been made in the treatment of SSc-ILD based on several clinical trials. The recommendations for immunosuppressive treatment have been modified and supplemented with targeted agents (tocilizumab, rituximab), and antifibrotic drugs such as nintedanib registered as a new treatment for SSc-ILD. However, there are no clear recommendations regarding the start and timing of nintedanib treatment. A debate on the early introduction of nintenadib or not took place on the 7th edition of the International Congress on Controversies in Rheumatology and Autoimmunity (CORA) in March/2023, and this review summarizes the main arguments that were discussed in this session., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paolo Spagnolo reports a relationship with Boehringer Ingelheim Pharmaceuticals Inc. that includes: board membership, consulting or advisory, funding grants, and speaking and lecture fees. Paolo Spagnolo reports a relationship with PPM Services SA that includes: consulting or advisory, funding grants, and travel reimbursement. Paolo Spagnolo reports a relationship with Novartis that includes: board membership and consulting or advisory. Paolo Spagnolo reports a relationship with Roche that includes: funding grants. Paolo Spagnolo reports a relationship with CSL Behring LLC that includes: board membership. Paolo Spagnolo reports a relationship with Pieris Pharmaceuticals Inc. that includes: consulting or advisory. Paolo Spagnolo reports a relationship with A Menarini International Pharmaceutics that includes: speaking and lecture fees. Paolo Spagnolo reports a relationship with Galapagos that includes: board membership and consulting or advisory. Paolo Spagnolo reports a relationship with Chiesi Pharmaceuticals Inc. that includes: speaking and lecture fees. Elisabetta Zanatta reports a relationship with Boehringer Ingelheim Pharmaceuticals Inc. that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Gabriella Szucs reports a relationship with Boehringer Ingelheim Pharmaceuticals Inc. that includes: speaking and lecture fees., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)