What is your approach to a patient with generalized morphea, no systemic involvement but a positive RNA Polymerase III?

I would perform age-appropriate cancer screening given the link between RNA pol III and cancer. Otherwise, I would simply monitor for onset of systemic sclerosis or other autoimmune disease symptoms.

It would be helpful to double-check if RNA Polymerase III Ab is a true positive- repeat in 4 weeks. If this is a high titer, I would take it very seriously. Here are a few suggestions-

1. Watch closely for the development of other signs of Systemic sclerosis - do they have Raynaud's? Nailfold capillary abnormalities? ILD?
2. Screen aggressively for malignancy.
3. Have the patient procure a BP meter given the risk for renal crisis with this marker, and counsel them on when to seek care urgently.
4. What trea...

I would do following:

• Monitor for the development of scleroderma skin and systemic involvement
• Monitor for renal crisis
• Cancer screening - age appropriate and pan CT due to cancer risk association with RNA Pol III ab

If generalized morphea- active with spreading lesions, would consider either Cellcept or Methotrexate for treatment.