A retrospective cohort study (n = 151) has found that a watch-and-wait strategy can be an effective approach for deciding when to start immunosuppressive therapy in patients newly diagnosed with systemic sclerosis-associated interstitial lung disease (SSc-ILD). Patients treated or not treated with immunosuppressive regimens were compared in terms of their characteristics at the time of ILD diagnosis and a decision model for watchful waiting was developed. Patients who were eligible for watchful waiting (i.e. untreated individuals) had improved survival, were less likely to have gastrointestinal involvement or pulmonary arterial hypertension (PAH), and had less pulmonary involvement compared with treated individuals. The authors conclude that watchful waiting could be effective for SSc-ILD patients with minimal pulmonary involvement and without PAH.