Clinical features |
|
⊠ Yes
|
□ No
|
Skin thickening |
Describe location, extent, progression: |
|
Both fingers and arms above elbows, both feet and lower legs |
□ Yes
|
⊠ No
|
Abnormal nailfold capillaries consistent with scleroderma |
□ Yes
|
⊠ No
|
Calcinosis |
□ Yes
|
⊠ No
|
Digital pulp loss or acro-osteolysis |
□ Yes
|
⊠ No
|
Dysphagia for solids |
□ Yes
|
⊠ No
|
Esophageal dilation |
□ Yes
|
⊠ No
|
Finger flexion contracture |
□ Yes
|
⊠ No
|
Finger tip ulcers or pitting scars |
⊠ Yes
|
□ No
|
Puffy fingers |
□ Yes
|
⊠ No
|
Interstitial lung disease or pulmonary fibrosis |
□ Yes
|
⊠ No
|
Pulmonary arterial hypertension |
⊠ Yes
|
□ No
|
Gastro-esophageal reflux disease |
⊠ Yes
|
□ No
|
Raynaud’s phenomenon |
□ Yes
|
⊠ No
|
Renal crisis |
⊠ Yes
|
□ No
|
Telangiectasias |
□ Yes
|
⊠ No
|
Tendon or bursal friction rubs |
|
Laboratory features |
|
⊠ Positive
|
□ Negative
|
Antinuclear antibody |
□ Positive
|
⊠ Negative
|
Anti-centromere antibody |
□ Positive
|
⊠ Negative
|
Anti-topoisomerase-I antibody |
□ Positive
|
⊠ Negative
|
Anti-PM-Scl antibody |
⊠ Positive
|
□ Negative
|
Anti-RNA polymerase III antibody |
|
Investigations |
|
□ Yes
|
⊠ No
|
DLCO < 80% predicted |
□ Yes
|
⊠ No
|
FVC < 80% predicted |
|
Any other information which may be relevant to the probability this patient has Systemic Sclerosis: |