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.