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Rheumatology

Systemic sclerosis   

Questions discussed in this category

What are the principal clinical and laboratory findings that lead a community rheumatologist to refer patients with scleroderma and lupus to a tertiary care center?
1 Answer available
How would you manage a patient with diffuse Systemic Sclerosis who develops severe rapidly progressive calcinosis?
1 Answer available
What protective post-op measures do you recommend for a patient with scleroderma and a history of ILD, PH, Raynaud’s and digital ischemia undergoing cardiothoracic surgery?
1 Answer available
What is the approach to use of ACE inhibitors for suspected scleroderma renal crisis in patients with only mildly elevated BP and renal artery stenosis?
2 Answers available
How would you approach management of a patient with rapidly progressive systemic sclerosis with worsening skin disease, myositis, arthritis, dysphagia and failure to thrive developing within 6 months?
The patient is a young African American female of reproductive age with positive Fibrillarin antibody and nucleolar antibody. No ILD.
1 Answer available
For patients with scleroderma at high risk of renal crisis, would you feel comfortable giving corticosteroids as pre-medication for rituximab?
1 Answer available
Is there a role for systemic therapy for a patient with scleroderma sine sclerosis, with esophageal strictures and Raynaud’s syndrome, but no pulmonary involvement?
1 Answer available
What treatment regimen for UVA-1 have you found most helpful in treating sclerotic diseases (e.g. morphea, scleroderma)?
4 Answers available
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
3 Answers available
In a patient with history of scleroderma renal crisis resulting in ESRD, would you recommend using steroids for when needed?
1 Answer available
How do you manage calcium and vitamin D replacement in scleroderma and myositis patients with dysphagia and malabsorption?
1 Answer available
Would you consider rituximab in a patient with severe GI dysmotility caused by scleroderma?
2 Answers available
Do you recommend treatment of worsening skin thickening with Limited Scleroderma +ANA+centromere and if so with what agent would you use?
(Only associated with mild PAH(PAP 38) and with esophageal dysmotility as well.)
2 Answers available
How common are nasal telangiectasia in patients with systemic sclerosis?
Patient with pulmonary hypertension (mixed group 1, 2, 3), COPD, HFpEF, Raynaud’s phenomenon, UCTD (ANA, PM-Scl, SSA-52kd), and recurrent severe...
1 Answer available
What is your approach towards initial regimen and tapering of mycophenolate in scleroderma?
Does your approach differ if treating more ILD versus cutaneous disease?
2 Answers available
How do you specifically counsel patients on conservative measures such as hand warming in the treatment of SSc associated digital ulceration?
In addition to the usual pharmcotherapy (CCBs, etc.) 
1 Answer available
What treatment options do you recommend to patients with microstomia secondary to scleroderma?
Have you tried hyaluronidase? 
2 Answers available
How do you manage severe Raynaud's phenomenon with ulceration in scleroderma patients that is refractory to oral agents (CCBs, PDEis, ARBs, and ERAs)?
2 Answers available
Is there any role of sympathectomy in Raynaud’s disease?
2 Answers available
When is the index of suspicion high for paraneoplastic systemic sclerosis in terms of clinical and serological presentation and how will you work it up?
Does it mirror the same approach as SSc without malignancy? Do patients with paraneoplastic SSc present atypically (without usual serologies or featur...
1 Answer available
How do you monitor a patient with scleroderma during pregnancy?
1 Answer available
How would you escalate therapy beyond MMF in a patient with rapidly progressive SSc-ILD?
When would you consider referral for lung transplant?
2 Answers available
In the absence of lung disease, do you prefer methotrexate or mycophenolate mofetil in the initial treatment of cutaneous-only manifestations in systemic sclerosis?
2 Answers available
How do you mitigate the risk of renal crisis from corticosteroids in a patient with UCTD?
1 Answer available
Is there a role for cyclophosphamide in refractory digital ischemia in patients with scleroderma?
1 Answer available
Is nailfold capillaroscopy useful for prognostication and evaluation of disease progression in MCTD/myositis patients?
1 Answer available
Is there a role for IVIG in the treatment of active morphea refractory to immunosuppressive agents?
1 Answer available
Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?
1 Answer available
How do you utilize methotrexate and/or hydroxychloroquine in the setting of limited scleroderma/CREST?
1 Answer available
Is nailfold capillaroscopy useful for prognostication and evaluation of disease progression in scleroderma patients?
1 Answer available
How do you approach the use of endothelin receptor antagonists in patients with scleroderma renal crisis and hypertension refractory to maximum ACE inhibition and calcium channel blockers?
1 Answer available
How do you approach the use of steroids for active muscle disease in patients with scleroderma-myositis overlap syndromes?
1 Answer available
How do you approach infused prostacyclin therapy for critical digital ischemia?
What factors go into choosing the right patient and determining length of therapy?
1 Answer available
How do you approach the management of SSc-ILD in a patient on immune checkpoint therapy?
1 Answer available
Are there scenarios where you send additional antibodies beyond anti-centromere, Scl-70, and RNA polymerase III in suspected scleroderma patients?
1 Answer available
How do you approach immunosuppression targeting skin thickening in scleroderma after the initial three years of onset?
(Skin thickening in the absence of visceral disease)
1 Answer available
How will you use tocilizumab in the treatment algorithm for SSc-ILD, given its recent FDA approval?
1 Answer available
How do you treat Raynaud's in patients with baseline low blood pressure?
1 Answer available
Is there a role for anti-IL6 therapy in SSc-associated ILD?
1 Answer available
What's the best treatment for calcinosis universalis in a scleroderma patient?
1 Answer available
What is the role of nintedanib in the treatment of SSc-ILD?
The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...
2 Answers available
When is it appropriate to refer a systemic sclerosis patient for bone marrow transplant evaluation?
2 Answers available


Papers discussed in this category

The New England journal of medicine, 2018-01-04
Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma.
N. Engl. J. Med., 2019 May 20
Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease.
The Lancet. Respiratory medicine, 2016-09
Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial.
The New England journal of medicine, 2006-06-22
Cyclophosphamide versus placebo in scleroderma lung disease.
Autoimmun Rev, 2019 Sep 11
Fast track algorithm: How to differentiate a "scleroderma pattern" from a "non-scleroderma pattern".
Clin Exp Rheumatol, 2020 Aug 26
Consensus-based evaluation of dermatoscopy versus nailfold videocapillaroscopy in Raynaud's phenomenon linking USA and Europe: a European League against Rheumatism study group on microcirculation in rheumatic diseases project.
Microvasc Res, 2016 Sep 07
Capillary density: An important parameter in nailfold capillaroscopy.
J Rheumatol, 2019 Aug 15
Nailfold Videocapillaroscopy in Systemic Sclerosis-related Pulmonary Arterial Hypertension: A Systematic Literature Review.
The British journal of dermatology, 2019-11
Utilization patterns and performance of commercial myositis autoantibody panels in routine clinical practice.
Front Med (Lausanne), 2021 Aug 10
Nailfold Capillaroscopy Abnormalities Correlate With Disease Activity in Adult Dermatomyositis.
Autoimmun Rev, 2022 Apr 12
Standardised interpretation of capillaroscopy in autoimmune idiopathic inflammatory myopathies: A structured review on behalf of the EULAR study group on microcirculation in Rheumatic Diseases.
Clin Rheumatol, 2014 Oct 17
Nailfold capillaroscopic changes in dermatomyositis and polymyositis.
Clin Rheumatol, 2019 Aug 22
Nailfold videocapillaroscopy alterations in dermatomyositis, antisynthetase syndrome, overlap myositis, and immune-mediated necrotizing myopathy.
Reumatologia, 2022 Feb 28
Nailfold capillaroscopy changes with disease activity in patients with inflammatory myositis including overlap myositis, pure dermatomyositis, and pure polymyositis.
Rheumatology (Oxford), 2022 Mar 14
Nailfold microvascular abnormalities are associated with a higher prevalence of pulmonary arterial hypertension in patients with MCTD.
Lancet Respir Med, 2020 Aug 28
Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial.
Arthritis Rheumatol, 2021 Feb 03
Tocilizumab Prevents Progression of Early Systemic Sclerosis Associated Interstitial Lung Disease.
Semin Arthritis Rheum,
Autoantibodies in systemic sclerosis.
Ann Rheum Dis, 2016 Nov 09
Update of EULAR recommendations for the treatment of systemic sclerosis.
QJM, 2013 May 21
Targeting the endothelin axis in scleroderma renal crisis: rationale and feasibility.
Eur J Dermatol,
Response of recalcitrant generalized morphea to intravenous immunoglobulins (IVIg): three cases and a review of the literature.
Case reports in rheumatology, 2017
A Rare Case of Digital Ischemia and Gangrene in ANCA-Associated Vasculitis with Review of the Literature.
Trials, 2017 Jun 15
Rituximab versus cyclophosphamide for the treatment of connective tissue disease-associated interstitial lung disease (RECITAL): study protocol for a randomised controlled trial.
Annals of the rheumatic diseases, 2018-08
Autoantibodies and scleroderma phenotype define subgroups at high-risk and low-risk for cancer.
J Scleroderma Relat Disord, 2020 Mar 17
Advances at the Interface of Cancer and Systemic Sclerosis.
Lupus, 2017 May 08
Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus.
Arthritis care & research, 2018-10
Impact of Radiation Therapy on Scleroderma and Cancer Outcomes in Scleroderma Patients With Breast Cancer.
Breast Care (Basel), 2019 Aug 16
Incidence of Morphea following Adjuvant Irradiation of the Breast in 2,268 Patients.
Cureus, 2015 Jun 16
Hereditary Hemorrhagic Telangiectasia with Unusual Associations.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2005 May
Late recurrence of scleroderma renal crisis in a renal transplant recipient despite angiotensin II blockade.

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