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)

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.