DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of scleroderma.
Alternative NamesSystemic Sclerosis
The physician may suspect scleroderma after taking a history of the symptoms and performing a physical examination. As part of this examination, the physician does the following:
Tests for Antinuclear Antibodies
Tests may be conducted to detect immune factors called antinuclear antibodies (ANAs). Elevated levels of ANA are found in 95% of patients with scleroderma. Antinuclear antibodies, however, are also strongly present in patients with many other autoimmune diseases, including systemic lupus erythematosus. Many people can also have high levels and never develop any of these diseases.
Detecting ANA subtypes may provide some weight in diagnosing scleroderma. Such subtypes include the following:
These antibodies are also found in other rheumatologic disorders, however; so detecting them does not necessarily prove scleroderma.
High frequency ultrasonography may be used to detect effects of scleroderma in patients hands.
Diagnosing Systemic Complications
Diagnosing Lung Complications. Changes in the lungs may occur early in lung disease, and prompt treatment is critical to prevent complications. Therefore once a diagnosis is made, the physician will check for lung changes:
Diagnosing Heart Complications. Patients with suspected heart involvement should have electrocardiography, echocardiography, or radionucleotide ventriculography. Advanced imaging techniques, such as single photon emission tomography (SPET), may also be useful to determine the extent of heart involvement in scleroderma patients.
Diagnosing Gastrointestinal Complications. Gastrointestinal problems may be detected using endoscopy (the insertion of a tube down the esophagus that contains a small camera and other instruments) or with manometry, a test that measures the pressure exerted by the muscles in the esophagus. Electrogastrography (EGG) measures the electrical activity in muscle in the stomach and may be an effective method for detecting stomach problems.
Ruling out Other Conditions
Other Autoimmune and Connective Tissue Disorders. A number of other autoimmune conditions affect connective tissue and can strongly resemble and even occur at the same with scleroderma. They include the following:
Symptoms of such diseases also may include fever, arthritis, muscle aches, rash, and lung and heart involvement.
Eosinophil Fasciitis. Eosinophilic fasciitis is a muscle disorder that is known to occur after intense exertion. It can cause symptoms similar to scleroderma, including pain, swelling, and tenderness in the hands and feet as well as skin thickening. The disorder can be ruled out if blood tests show elevated sedimentation rate and no antinuclear antibodies.
Conditions Associated with Raynauds phenomenon and other Symptoms of Scleroderma. Although Raynauds phenomenon occurs in most scleroderma patients, over 80% of cases of Raynauds phenomenon are harmless. In one study, only 12% of Raynaud's cases was associated with some other condition, and few of those are scleroderma. The following are other problems that might accompany or cause Raynaud's phenomenon: