Scleroderma

Question 1

Symptoms

Answer 1

This can present as a polyarthritis affecting the fingers of the hand in 25% of patients, esp. in the early stages.

Mainly affects the skin, presenting with Raynaud phenomenon in over 85%.

Question 2

Dx Triad

Answer 2

finger discomfort + arthralgia + GORD (± skin tightness)

Question 3

Investigations

Answer 3

No specific diagnostic tests

ESR may be raised

Antinuclear Abs → 90% +ve

Rheumatoid factor—+ve in 30%

Antinucleolar and anticentromere Abs—specific

Question 4

Treatment

Answer 4

Analgesics and NSAIDs for pain

Avoid vasospasm (no smoking, β blockers, ergotamine)

CCBs as for Raynaud

D-penicillamine for skin or systemic involvement

Proton-pump inhibitors for GORD