The Differential Diagnosis of Systemic Sclerosis

Alan Tyndall; Susanna Fistarol


Curr Opin Rheumatol. 2013;25(6):692-699. 

In This Article

Overlap Connective Tissue Diseases

On occasion, scleroderma-like changes will be present in overlap CTDs and may also be a paraneoplastic phenomenon. The 70-year-old patient in Fig. 8 presented with puffy fingers, Raynaud's phenomenon, nonspecific capillaroscopy changes and digital necrosis. Antinuclear antibody (ANA) was 1/5200 (nucleolar pattern), but negative for all other subgroups of autoantibodies. She had a red swollen face resembling dermatomyositis sine myositis. Chest radiograph, breast exam and abdominal ultrasound were normal. Undifferentiated connective tissue disease (UCTD) was diagnosed, but 18 months later new dyspeptic abdominal pain led to a diagnosis of gastric carcinoma.

Figure 8.

Puffy fingers, Raynaud's phenomenon, digital ischaemia and facial swelling and erythema were not associated with SSc like nailfold capillaroscopy or scleroderma-specific autoantibodies despite the high ANA. ANA, antinuclear antibody; SSc, systemic sclerosis.