Systemic Sclerosis

Hand involvement: note dystrophic scarring of the fingertips.

Clinical Background:

A 38 year old male patient.
Onset at the age of 34 years with stiffness and Raynaud's phenomenon soon followed by swelling of the fingers due to soft tissue edema and a symmetric polyarthritis involving the hands, wrists, elbows, ankles and knees.   For two years he received NSAIDs alone with significant improvement in the articular symptoms.
Because of the progression of hand involvement he was referred to our Department.
Physical examination revealed sclerodactyly and dystrophic scarring of the fingertips but no typical face involvement or proximal scleroderma.   Laboratory investigations showed antinuclear and anti-Scl 70 autoantibodies.
Respiratory function tests were not significant while esophageal manometry demonstrated initial asymptomatic esophageal involvement with normal acid exposure on 24-hour pH-monitoring.
No signs of calcinosis on the hand X-rays and a scleroderma pattern (slow) at capillaroscopy were observed.
The patient was discharged on penicillamine and nifedipine.

All contents copyright of the "On-line Archives of Rheumatology", 1996