How Often Should
a Patient with Diffuse Scleroderma Have Checkups?
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 going to an
internist once a year adequate care for a patient with diffuse
scleroderma?
Answer:
Early in the course of diffuse scleroderma, the skin
tends to thicken rapidly, which leads to loss of flexibility
and function. In addition, there is significant risk of developing
heart, lung, and kidney involvement.
The thickening of
skin eventually stabilizes or plateaus about 1–3 years
after the onset of scleroderma.
Within the next several
years, the majority of people with diffuse scleroderma have
a stage in which the skin softens. When the skin softens,
it usually also means that the likelihood of new or significant
progression of already present heart, lung, and kidney involvement
lessens.
Therefore, in the
first few years of diffuse scleroderma, I think a patient
should be seen by a knowledgeable internist or rheumatologist
at least every 3–4 months.
In addition, I think
that person should also have lung-function tests every 6 months,
and an echocardiogram every 12 months for the first 3–5
years. This should pick up early involvement of the heart
or lungs, which allows early treatment if needed.
The person should
also obtain a blood-pressure cuff for home use, and take her/his
blood pressure three times a week to pick up kidney involvement
at a very early stage.
Once the person's
scleroderma has quieted, there is less need for frequent medical
intervention. At this point, a knowledgeable practitioner
might need or want that person to return every 6–12 months
for follow-up, unless there are active problems that need
more frequent attention. |
