Hsu VM, et al. - In this prospective cohort study (PHAROS), authors assessed 236 at-risk cases, followed for a median of 4 years to study the natural history of pulmonary hypertension (PH) in systemic sclerosis (SSc) between 2005 and 2014. They noticed 35 candidates who developed PH after entering PHAROS (reclassified as PH group). They found a strong relationship of higher mortality with male sex, low %DLCO, exercise oxygen desaturation, anemia, abnormal dyspnea scores, and baseline pericardial effusion in the at-risk group. An association of risks for cardiopulmonary hospitalization with increased dyspnea and pericardial effusions was noted. They noticed PH cases with DLCO < 50% with the highest risk of cardiopulmonary hospitalizations.