Scleroderma physical examination: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Khurram Afzal (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators, Widget editors
1,615 edits
Khurram Afzal (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators, Widget editors
1,615 edits
No edit summary
Line 5: Line 5:


==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 telangiectasis.
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>


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with scleroderma usually appear anxious.
*Patients with scleroderma usually appear anxious


===Vital Signs===
===Vital Signs===
Line 17: Line 17:


===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>
*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>
*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>
*Calcinosis
*[[Calcinosis]]


===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.<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>
*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>


===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 39:


===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>
*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>


==References==
==References==

Revision as of 00:18, 18 April 2018

Scleroderma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Scleroderma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Scleroderma physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Scleroderma physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Scleroderma physical examination

CDC on Scleroderma physical examination

Scleroderma physical examination in the news

Blogs on Scleroderma physical examination

Directions to Hospitals Treating Scleroderma

Risk calculators and risk factors for Scleroderma physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

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]

Appearance of the Patient

  • Patients with scleroderma usually appear anxious

Vital Signs

  • Vital signs of patients with scleroderma are usually normal

Skin

HEENT

  • HEENT examination of patients with scleroderma is usually normal

Neck

Lungs

Heart

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

References

  1. ↑ 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. ↑ 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. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Wigley FM (September 2002). "Clinical practice. Raynaud's Phenomenon". N. Engl. J. Med. 347 (13): 1001–8. doi:10.1056/NEJMcp013013. PMID 12324557.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Scleroderma_physical_examination&oldid=1463599"