The Initial Effects
of Diffuse Scleroderma
By Philip Clements,
M.D., M.P.H., UCLA School of Medicine, Dept. of Rheumatology
(originally published in Scleroderma Voice, 2002 #2)
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|
Philip
Clements , M.D., M.P.H. |
Question:
Is it true that the effects of diffuse scleroderma start at
the top of the body and travel down?
Answer:
Scleroderma usually begins as one of three complaints:
(1) puffy hands;
(2) Raynaud's phenomenon;
or
(3) joint pain or
arthritis.
Diffuse scleroderma
tends to affect the hands first, then moves up the arm (and
feet and legs in some people) to involve the upper arms, the
thighs, the belly, and the chest. The face is usually affected
early in the illness.
To determine the
risk of possible internal involvements in diffuse scleroderma,
we need to know how long the person has had scleroderma since
it first began (usually the time when one of those initial
three manifestations I mentioned above occurred).
If it has been more
than 5 years since the onset of scleroderma, and there is
not yet significant heart, lung, or kidney involvement, it
is unlikely that new heart, lung or kidney involvement will
begin after this time.
If someone is still
within the first one or two years of scleroderma onset, there
is potential for heart, lung, and kidney involvement. This
needs to be screened for by patient and physician.
Gut involvement tends
to have its own timetable, and does not really tell us much
about the rest of the disease course or the risk of other
internal involvements. |
