Diagnosis

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Because scleroderma's symptoms vary in severity and type, it may be hard to get a definitive, positive diagnosis in the early stages of the disease. Consult a health care professional if you have any of the symptoms listed below, but remember that none of these necessarily mean you have scleroderma:

• pitted scars on the fingertips

• thickening or hardening of the skin (either in small patches or over larger portions of the face, hands and feet)

• finger ulcerations (sores)

• Raynaud's phenomenon; almost every scleroderma patients has this condition. Raynaud's can involve an abnormal sensitivity to cold in the extremities; a temporary change in hand and foot color to bluish or white or a change in sensation in the fingers and toes; pain; and occasionally ulcers of the fingertips or toes. Remember, however, that most patients with Raynaud's never progress to other symptoms of scleroderma.

• swelling and thickening of the skin on the hands and feet

• pain and stiffness of the joints

• joint contractures

• digestive system and gastrointestinal tract problems, especially heartburn, and problems with food getting stuck in the esophagus on the way to the stomach.

• dry mucus membranes

• kidney, heart and lung problems

• nonspecific symptoms such as extreme fatigue, generalized weakness, weight loss and vague aching of muscles, joints and bones

• shortness of breath with lung x-rays showing fibrosis

Another factor making diagnosis difficult is that many of these symptoms are common to other diseases, especially other connective-tissue diseases such as rheumatoid arthritis, lupus and polymyositis (muscle inflammation).

In addition to the symptoms and physical changes apparent on examination, health care professionals may look at blood tests measuring autoantibodies (such as the Antinuclear Antibody Test), along with the nailfold capillary test. Based on the observation that small capillaries in the hands may be dilated or disappear early on in scleroderma patients, the test involves taking a microscopic look at skin under the fingernail, to see if capillaries look normal.

You may need to consult a number of health care professionals before receiving an accurate diagnosis. Remember that the results from one test alone can not conclusively determine whether you have scleroderma. It may take a team of health care professionals to analyze various test results. They will probably also need to look at your complete medical history before making a definitive diagnosis.