Scleroderma physical examination: Difference between revisions
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{{Scleroderma}} | {{Scleroderma}} | ||
{{CMG}}; {{AE}} {{MKA}} | {{CMG}}; {{AE}} {{MKA}}, {{KS}} | ||
==Overview== | ==Overview== | ||
Patients with scleroderma usually appear anxious. Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis and | Patients with scleroderma usually appear anxious. Physical examination of patients with scleroderma is usually remarkable for [[sclerodactyly]], [[Raynaud's phenomenon]], digital [[ulcers]], [[skin]] [[fibrosis]], and [[Telangiectasis|telangiectasias]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis and telangiectasis.<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | Physical examination of patients with scleroderma is usually remarkable for [[sclerodactyly]], [[Raynaud's phenomenon]], digital [[ulcers]], [[skin]] [[fibrosis]], and [[telangiectasis]].<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with scleroderma usually appear anxious | *Patients with scleroderma usually appear anxious | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Vital signs of patients with scleroderma are usually normal | *Vital signs of patients with scleroderma are usually normal | ||
*[[Hypertension]] maybe present<ref name="pmid20534372">{{cite journal |vauthors=Khanna D, Denton CP |title=Evidence-based management of rapidly progressing systemic sclerosis |journal=Best Pract Res Clin Rheumatol |volume=24 |issue=3 |pages=387–400 |date=June 2010 |pmid=20534372 |pmc=2884006 |doi=10.1016/j.berh.2009.12.002 |url=}}</ref> | |||
===Skin=== | ===Skin=== | ||
*Skin induration<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref> | *[[Skin]] [[induration]]<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
*Skin fibrosis<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref> | *[[Skin]] [[fibrosis]]<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref><ref name="pmid24442715">{{cite journal |vauthors=Abignano G, Del Galdo F |title=Quantitating skin fibrosis: innovative strategies and their clinical implications |journal=Curr Rheumatol Rep |volume=16 |issue=3 |pages=404 |date=March 2014 |pmid=24442715 |doi=10.1007/s11926-013-0404-5 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
*Telangiectasias<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | *[[Telangiectasias]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
*Calcinosis | *[[Calcinosis]]<ref name="pmid6607734">{{cite journal |vauthors=Steen VD, Ziegler GL, Rodnan GP, Medsger TA |title=Clinical and laboratory associations of anticentromere antibody in patients with progressive systemic sclerosis |journal=Arthritis Rheum. |volume=27 |issue=2 |pages=125–31 |date=February 1984 |pmid=6607734 |doi= |url=}}</ref> | ||
===HEENT=== | ===HEENT=== | ||
*HEENT examination of patients with scleroderma is usually normal | *HEENT examination of patients with scleroderma is usually normal | ||
===Neck=== | ===Neck=== | ||
*Jugular venous distention maybe present suggesting right heart failure due to pulmonary hypertension | *[[Jugular venous distention]] maybe present suggesting [[right heart failure]] due to [[pulmonary hypertension]] | ||
===Lungs=== | ===Lungs=== | ||
*Pulmonary examination of patients with scleroderma is usually normal | *[[Pulmonary]] examination of patients with scleroderma is usually normal | ||
*Inspiratory [[crackles]] upon auscultation of the lung are suggestive of interstitial lung disease | *Inspiratory [[crackles]] upon [[auscultation]] of the [[lung]] are suggestive of [[interstitial lung disease]]<ref name="pmid26324802">{{cite journal |vauthors=Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M |title=Interstitial lung disease in systemic sclerosis: where do we stand? |journal=Eur Respir Rev |volume=24 |issue=137 |pages=411–9 |date=September 2015 |pmid=26324802 |doi=10.1183/16000617.00002915 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
===Heart=== | ===Heart=== | ||
*Right ventricular heave can be suggestive of pulmonary arterial hypertension (PAH) | *Right [[ventricular]] [[heave]] can be suggestive of [[Pulmonary arterial hypertension|pulmonary arterial hypertension (PAH)]] | ||
===Abdomen=== | ===Abdomen=== | ||
| Line 39: | Line 40: | ||
===Back=== | ===Back=== | ||
* Back examination of patients with scleroderma is usually normal | * Back examination of patients with scleroderma is usually normal | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with scleroderma is usually normal | * Genitourinary examination of patients with scleroderma is usually normal | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Neuromuscular examination of patients with scleroderma is usually normal | *Neuromuscular examination of patients with scleroderma is usually normal | ||
===Extremities=== | ===Extremities=== | ||
*Myopathy<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref> | *[[Myopathy]]<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref> | ||
*Ulceration of finger tips (ischemic)<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref> | *[[Ulceration]] of finger tips ([[ischemic]])<ref name="pmid19487217">{{cite journal |vauthors=Krieg T, Takehara K |title=Skin disease: a cardinal feature of systemic sclerosis |journal=Rheumatology (Oxford) |volume=48 Suppl 3 |issue= |pages=iii14–8 |date=June 2009 |pmid=19487217 |doi=10.1093/rheumatology/kep108 |url=}}</ref> | ||
*Contractures of finger flexion | *[[Contractures]] of finger [[flexion]] | ||
*Raynaud's phenomenon<ref name="pmid12324557">{{cite journal |vauthors=Wigley FM |title=Clinical practice. Raynaud's Phenomenon |journal=N. Engl. J. Med. |volume=347 |issue=13 |pages=1001–8 |date=September 2002 |pmid=12324557 |doi=10.1056/NEJMcp013013 |url=}}</ref> | *[[Raynaud's phenomenon]]<ref name="pmid12324557">{{cite journal |vauthors=Wigley FM |title=Clinical practice. Raynaud's Phenomenon |journal=N. Engl. J. Med. |volume=347 |issue=13 |pages=1001–8 |date=September 2002 |pmid=12324557 |doi=10.1056/NEJMcp013013 |url=}}</ref><ref name="pmid20453602">{{cite journal |vauthors=Hudson M, Fritzler MJ, Baron M |title=Systemic sclerosis: establishing diagnostic criteria |journal=Medicine (Baltimore) |volume=89 |issue=3 |pages=159–65 |date=May 2010 |pmid=20453602 |doi=10.1097/MD.0b013e3181dde28d |url=}}</ref> | ||
*Dilatation of nailfold capillaries<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | *[[Dilatation]] of nailfold [[capillaries]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | ||
*Sclerodactyly<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | *[[Sclerodactyly]]<ref name="pmid24092682">{{cite journal |vauthors=van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE |title=2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=72 |issue=11 |pages=1747–55 |date=November 2013 |pmid=24092682 |doi=10.1136/annrheumdis-2013-204424 |url=}}</ref><ref name="pmid26210125">{{cite journal |vauthors=Pope JE, Johnson SR |title=New Classification Criteria for Systemic Sclerosis (Scleroderma) |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=3 |pages=383–98 |date=August 2015 |pmid=26210125 |doi=10.1016/j.rdc.2015.04.003 |url=}}</ref> | ||
==Gallery== | |||
===Skin=== | |||
<gallery perrow="3"> | |||
Image:Progressive systemic sclerosis 001.jpg|Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 002.jpg|Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 003.jpg|Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 004.jpg|Skin: Scleroderma; shoulders & back<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 005.jpg|Skin: Scleroderma in crest syndrome; calcinosis at elbow<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 006.jpg|Hands: Scleroderma<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 007.jpg|Hand: Scleroderma, finger, posterior nail fold<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 008.jpg|Skin: Scleroderma, chest, salt and pepper pigmentation<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 009.jpg|Leg: Morphea, circumscribed scleroderma; age 19<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Progressive systemic sclerosis 010.jpg|Face: Morphea, circumscribed scleroderma<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Systemic sclerosis finger.jpg|Clinical appearance of acrosclerotic piece-meal [[necrosis]] of the thumb in a patient with systemic sclerosis<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:Left Arm Scleroderma Patient .jpg|Left arm of Scleroderma patient, showing skin lesions<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
Image:MercMorphea.JPG|Morphea<br><small>Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [http://www.peir.net]</small> | |||
</gallery> | |||
=====Scalp===== | |||
<gallery> | |||
Image:Linear scleroderma10.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
</gallery> | |||
=====Trunk===== | |||
<gallery> | |||
Image:Linear scleroderma01.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma02.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
</gallery> | |||
=====Extremity===== | |||
<gallery> | |||
Image:Linear scleroderma03.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma04.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma05.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma06.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma07.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma08.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
Image:Linear scleroderma09.jpg|Linear scleroderma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | |||
</gallery> | |||
==References== | ==References== | ||
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[[Category:Dermatology]] | |||
[[Category:Rheumatology]] | |||
Latest revision as of 00:06, 30 July 2020
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Scleroderma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Scleroderma physical examination On the Web |
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American Roentgen Ray Society Images of Scleroderma physical examination |
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Risk calculators and risk factors for Scleroderma physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [15], Kiran Singh, M.D. [16]
Overview
Patients with scleroderma usually appear anxious. Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis, and telangiectasias.
Physical Examination
Physical examination of patients with scleroderma is usually remarkable for sclerodactyly, Raynaud's phenomenon, digital ulcers, skin fibrosis, and telangiectasis.[1][2][3]
Appearance of the Patient
- Patients with scleroderma usually appear anxious
Vital Signs
- Vital signs of patients with scleroderma are usually normal
- Hypertension maybe present[4]
Skin
HEENT
- HEENT examination of patients with scleroderma is usually normal
Neck
- Jugular venous distention maybe present suggesting right heart failure due to pulmonary hypertension
Lungs
- Pulmonary examination of patients with scleroderma is usually normal
- Inspiratory crackles upon auscultation of the lung are suggestive of interstitial lung disease[9][3]
Heart
- Right ventricular heave can be suggestive of pulmonary arterial hypertension (PAH)
Abdomen
Back
- Back examination of patients with scleroderma is usually normal
Genitourinary
- Genitourinary examination of patients with scleroderma is usually normal
Neuromuscular
- Neuromuscular examination of patients with scleroderma is usually normal
Extremities
- Myopathy[5]
- Ulceration of finger tips (ischemic)[6]
- Contractures of finger flexion
- Raynaud's phenomenon[11][3]
- Dilatation of nailfold capillaries[1][2]
- Sclerodactyly[1][2]
Gallery
Skin
-
![Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [1]](/images/a/ab/Progressive_systemic_sclerosis_001.jpg)
Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [1] -
![Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [2]](/images/9/9d/Progressive_systemic_sclerosis_002.jpg)
Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [2] -
![Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [3]](/images/3/3b/Progressive_systemic_sclerosis_003.jpg)
Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [3] -
![Skin: Scleroderma; shoulders & back Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [4]](/images/c/cb/Progressive_systemic_sclerosis_004.jpg)
Skin: Scleroderma; shoulders & back
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [4] -
![Skin: Scleroderma in crest syndrome; calcinosis at elbow Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [5]](/images/1/18/Progressive_systemic_sclerosis_005.jpg)
Skin: Scleroderma in crest syndrome; calcinosis at elbow
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [5] -
![Hands: Scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [6]](/images/2/23/Progressive_systemic_sclerosis_006.jpg)
Hands: Scleroderma
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [6] -
![Hand: Scleroderma, finger, posterior nail fold Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [7]](/images/1/1d/Progressive_systemic_sclerosis_007.jpg)
Hand: Scleroderma, finger, posterior nail fold
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [7] -
![Skin: Scleroderma, chest, salt and pepper pigmentation Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [8]](/images/e/e3/Progressive_systemic_sclerosis_008.jpg)
Skin: Scleroderma, chest, salt and pepper pigmentation
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [8] -
![Leg: Morphea, circumscribed scleroderma; age 19 Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [9]](/images/c/cc/Progressive_systemic_sclerosis_009.jpg)
Leg: Morphea, circumscribed scleroderma; age 19
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [9] -
![Face: Morphea, circumscribed scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [10]](/images/7/76/Progressive_systemic_sclerosis_010.jpg)
Face: Morphea, circumscribed scleroderma
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [10] -
![Clinical appearance of acrosclerotic piece-meal necrosis of the thumb in a patient with systemic sclerosis Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [11]](/images/c/c7/Systemic_sclerosis_finger.jpg)
-
![Left arm of Scleroderma patient, showing skin lesions Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [12]](/images/8/8a/Left_Arm_Scleroderma_Patient_.jpg)
Left arm of Scleroderma patient, showing skin lesions
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [12] -
![Morphea Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [13]](/images/7/71/MercMorphea.JPG)
Morphea
Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [13]
![Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [1]](/index.php/File:Progressive_systemic_sclerosis_001.jpg)
![Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [2]](/index.php/File:Progressive_systemic_sclerosis_002.jpg)
![Panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [3]](/index.php/File:Progressive_systemic_sclerosis_003.jpg)
![Skin: Scleroderma; shoulders & back Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [4]](/index.php/File:Progressive_systemic_sclerosis_004.jpg)
![Skin: Scleroderma in crest syndrome; calcinosis at elbow Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [5]](/index.php/File:Progressive_systemic_sclerosis_005.jpg)
![Hands: Scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [6]](/index.php/File:Progressive_systemic_sclerosis_006.jpg)
![Hand: Scleroderma, finger, posterior nail fold Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [7]](/index.php/File:Progressive_systemic_sclerosis_007.jpg)
![Skin: Scleroderma, chest, salt and pepper pigmentation Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [8]](/index.php/File:Progressive_systemic_sclerosis_008.jpg)
![Leg: Morphea, circumscribed scleroderma; age 19 Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [9]](/index.php/File:Progressive_systemic_sclerosis_009.jpg)
![Face: Morphea, circumscribed scleroderma Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [10]](/index.php/File:Progressive_systemic_sclerosis_010.jpg)
![Clinical appearance of acrosclerotic piece-meal necrosis of the thumb in a patient with systemic sclerosis Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [11]](/index.php/File:Systemic_sclerosis_finger.jpg)
![Left arm of Scleroderma patient, showing skin lesions Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [12]](/index.php/File:Left_Arm_Scleroderma_Patient_.jpg)
![Morphea Source:Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology [13]](/index.php/File:MercMorphea.JPG)
Scalp
-
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/a/a0/Linear_scleroderma10.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12]
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma10.jpg)
Trunk
-
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/a/a5/Linear_scleroderma01.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/a/a3/Linear_scleroderma02.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12]
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma01.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma02.jpg)
Extremity
-
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/e/ea/Linear_scleroderma03.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/6/6b/Linear_scleroderma04.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/f/f1/Linear_scleroderma05.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/3/31/Linear_scleroderma06.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/b/b3/Linear_scleroderma07.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/f/f1/Linear_scleroderma08.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12] -
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/images/d/dd/Linear_scleroderma09.jpg)
Linear scleroderma. Adapted from Dermatology Atlas.[12]
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma03.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma04.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma05.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma06.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma07.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma08.jpg)
![Linear scleroderma. Adapted from Dermatology Atlas.[12]](/index.php/File:Linear_scleroderma09.jpg)
References
- ↑ 1.0 1.1 1.2 1.3 van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE (November 2013). "2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative". Ann. Rheum. Dis. 72 (11): 1747–55. doi:10.1136/annrheumdis-2013-204424. PMID 24092682.
- ↑ 2.0 2.1 2.2 2.3 Pope JE, Johnson SR (August 2015). "New Classification Criteria for Systemic Sclerosis (Scleroderma)". Rheum. Dis. Clin. North Am. 41 (3): 383–98. doi:10.1016/j.rdc.2015.04.003. PMID 26210125.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Hudson M, Fritzler MJ, Baron M (May 2010). "Systemic sclerosis: establishing diagnostic criteria". Medicine (Baltimore). 89 (3): 159–65. doi:10.1097/MD.0b013e3181dde28d. PMID 20453602.
- ↑ Khanna D, Denton CP (June 2010). "Evidence-based management of rapidly progressing systemic sclerosis". Best Pract Res Clin Rheumatol. 24 (3): 387–400. doi:10.1016/j.berh.2009.12.002. PMC 2884006. PMID 20534372.
- ↑ 5.0 5.1 Shah AA, Wigley FM (April 2013). "My approach to the treatment of scleroderma". Mayo Clin. Proc. 88 (4): 377–93. doi:10.1016/j.mayocp.2013.01.018. PMC 3666163. PMID 23541012.
- ↑ 6.0 6.1 Krieg T, Takehara K (June 2009). "Skin disease: a cardinal feature of systemic sclerosis". Rheumatology (Oxford). 48 Suppl 3: iii14–8. doi:10.1093/rheumatology/kep108. PMID 19487217.
- ↑ Abignano G, Del Galdo F (March 2014). "Quantitating skin fibrosis: innovative strategies and their clinical implications". Curr Rheumatol Rep. 16 (3): 404. doi:10.1007/s11926-013-0404-5. PMID 24442715.
- ↑ Steen VD, Ziegler GL, Rodnan GP, Medsger TA (February 1984). "Clinical and laboratory associations of anticentromere antibody in patients with progressive systemic sclerosis". Arthritis Rheum. 27 (2): 125–31. PMID 6607734.
- ↑ Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M (September 2015). "Interstitial lung disease in systemic sclerosis: where do we stand?". Eur Respir Rev. 24 (137): 411–9. doi:10.1183/16000617.00002915. PMID 26324802.
- ↑ Shreiner AB, Murray C, Denton C, Khanna D (2016). "Gastrointestinal Manifestations of Systemic Sclerosis". J Scleroderma Relat Disord. 1 (3): 247–256. doi:10.5301/jsrd.5000214. PMC 5267349. PMID 28133631.
- ↑ Wigley FM (September 2002). "Clinical practice. Raynaud's Phenomenon". N. Engl. J. Med. 347 (13): 1001–8. doi:10.1056/NEJMcp013013. PMID 12324557.
- ↑ 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 "Dermatology Atlas".