The goal is to identify findings which may help a clinician to identify a patient who may need a more extensive evaluation or referral to a specialist.
Clues to the possible presence of systemic sclerosis:
(1) Raynaud's phenomenon
(2) visible mat-like telangiectasias
(3) sclerodactyly
(4) skin involvement proximal to the fingers
(5) nailfold capillary changes
(6) one or more systemic sclerosis-related autoantibodies
Systemic sclerosis-related autoantibodies include:
(1) anti-centromere antibody
(2) anti-topoisomerase I
(3) anti-RNA polymerase III
(4) anti-PM/Scl (polymyositis, scleroderma)
(5) anti-fibrillin
(6) anti-RNA polymerase I
(7) anti-fibrillarin
Additional findings may include:
(1) fingertip pitting scars (ulcers)
(2) loss of substance in digital finger pad
(3) finger contractures
(4) lung fibrosis
(5) pulmonary hypertension
(6) gastrointestinal involvement
(7) renal crisis
Performance:
• No single finding can make the diagnosis of systemic sclerosis.
• 10% of patients do not have a systemic sclerosis-related autoantibody.
• The ability to examine nails properly may not be available to all clinicians.
• Not all autoantibodies are readily available.
