How do you approach management of a patient presenting with clinical manifestations of systemic sclerosis (cutaneous involvement, Raynaud’s phenomenon, and pulmonary arterial hypertension) but negative serologies?  

Systemic sclerosis is a clinical diagnosis, and there are patients who don't demonstrate antibodies on currently available clinical labs. In addition, there are patients with mild phenotypes who may also not meet the current classification criteria. I think if the clinical syndrome is consistent wit...

Great answer by Dr. @Hummers! I would also suggest checking a more complete panel of scleroderma (and possibly myositis) antibodies, and if this were negative, consider a workup for underlying malignancy.