Description

Li et al identified red flags for systemic complications in patients with scleroderma. These can help to identify a patient who may benefit from more aggressive management. The authors are from Monash Medical Centre in Melbourne, Australia.


 

Patient selection: scleroderma

 

Red flags for renal involvement:

(1) hypertension

(2) deterioration in renal function

(3) malignant hypertensive crisis

(4) active urinary sediment with glomerular hematuria and proteinuria

(5) microangiopathic hemolytic anemia (MHA)

 

Red flags for pulmonary disease (interstitial lung disease, pulmonary arterial hypertension):

(1) dyspnea

(2) dry cough

(3) declining exercise intolerance

(4) signs of pulmonary hypertension and right heart failure

(5) fine end-expiratory crackles at lung bases

(6) declining pulmonary function tests (FVC, carbon monoxide diffusion capacity, etc)

 

Red flags for gastrointestinal tract involvement:

(1) iron deficiency anemia

(2) gastrointestinal bleeding

(3) gastroesophageal reflux disease (GERD)

(4) dysphagia and/or bloating

(5) constipation, diarrhea or fecal incontinence

 

Red flags in skin involvement:

(1) rapidly progressive skin changes

(2) severe Raynaud's phenomenon

(3) digital ulceration

(4) digital ischemia with infarction

 

Red flags of cardiac involvement:

(1) myocardial conduction defects

(2) pericarditis

(3) left heart failure

 

A patient with red flags should be evaluated more carefully and treated more aggressively.

 


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