Initial Diagnosis
Scleroderma or Systemic Sclerosis Defined
Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as an autoimmune disease. Hardening of the skin is one of the most visible manifestations of the disease. The disease varies from individual to individual. Scleroderma is not contagious, infectious, cancerous, or malignant. (National Scleroderma Foundation, 2023)
The ever-changing nature of symptoms can flare up and calm down. They’re not predictable, and it’s difficult to anticipate changes over time because symptoms and their effects on a person vary greatly.
Classification of Scleroderma
Limited cutaneous scleroderma
Raynaud phenomenon for years, occasionally decades
Skin involvement limited to hands, face, feet, and forearms (acral distribution)
Dilated nail fold capillary loops, usually without capillary drop-out
A significant (10 to 15 percent) late incidence of pulmonary hypertension, with or without skin calcification, gastrointestinal disease, telangiectasias (CREST syndrome), or interstitial lung disease
Renal disease rarely occurs
Anticentromere antibody (ACA) in 70 to 80 percent
Diffuse cutaneous scleroderma
Raynaud phenomenon followed, within one year, by puffy or hidebound skin changes
Truncal and acral skin involvement; tendon friction rubs
Nailfold capillary dilation and capillary drop-out
Early and significant incidence of renal, interstitial lung, diffuse gastrointestinal, and myocardial disease
Anti-Scl-70 (30 percent) and anti-RNA polymerase-I, II, or III (12 to 15 percent) antibodies
Scleroderma sine scleroderma
Presentation with pulmonary fibrosis or renal, cardiac, or gastrointestinal disease
No skin involvement
Raynaud phenomenon may be present
Antinuclear antibodies may be present – anti-Scl-70, ACA, or anti-RNA polymerase-I, II, or III
Environmentally induced scleroderma
Generally diffuse distribution of skin sclerosis and a history of exposure to an environmental agent suspected of causing scleroderma
Overlap syndromes
Features of systemic sclerosis that coexist with those of another autoimmune rheumatic disease, such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, vasculitis, or Sjögren’s syndrome.
Pre-scleroderma
Raynaud phenomenon
Nailfold capillary changes and evidence of digital ischemia
Specific circulating autoantibodies – anti-topoisomerase-l (Scl-70), anti-centromere(ACA), or anti-RNA polymerase-l, II, or III
Scleroderma-Related Symptoms You May Experience
Raynaud's Phenomenon
Raynaud’s phenomenon (say “ray-NOHZ”) occurs when the blood vessels in the hands and feet overreact to cold temperatures.
Calcinosis/Calcium Deposits
Calcium deposits can form in the connective tissues, which can be detected through an exam or X-ray imaging.
Esophageal dysfunction
An impaired esophagus function (the tube connecting the throat and the stomach) occurs when smooth muscles in the esophagus lose normal movement.
GERD/Reflux
Gastroesophageal reflux disease (GERD) is a common condition in which the acid moves up into the esophagus.
Skin Thickening/Sclerodactyly
Thick and tight skin on the fingers results from excess collagen deposits within skin layers.
Telangiectasia/Red Spots
A condition caused by swelling of tiny blood vessels, in which red spots appear on the hands and face.
Finger/Digital Ulcers
Around 40% of patients with scleroderma develop open sores on their fingertips, called digital ulcers.
Other Common Symptoms You May Experience
Pain
People with scleroderma are more likely to have pain than people without scleroderma. Pain can arise from the skin, muscles, joints, or nerves. Scleroderma causes pain in 60% to 83% of individuals.
Fatigue
People with scleroderma often experience a lack of energy, also called fatigue. Patients who experience fatigue often find this symptom frustrating because they were used to living an active life and now need to adjust their activity levels.
Sleep disturbance
People with scleroderma face unique challenges, such as pain, medications, low levels of physical activity, joint pain, and tightness. All of these challenges can affect your sleep.
Brain fog
People with scleroderma often experience brain fog, which is a term used to describe feeling mentally sluggish and fuzzy. Brain fog feels like a lack of mental clarity; it can affect your ability to focus and make it difficult to recall things.
Other symptoms to watch for include new onset swelling of fingers, ankles, or feet.
What Can I Do When First Diagnosed?
Being diagnosed with scleroderma can sometimes be viewed as scary or overwhelming. Scleroderma is a rare disease, and knowing that you are not alone is important!
While scleroderma can feel like a lonely disease, you don’t have to be alone. It’s okay to ask for help and support. You do have to shift to a new normal, and needing help during and after the transition is normal.
Here are a few things you can do as you adjust to living with this diagnosis.
Continue your life within your limits
Your goal is to pace yourself by balancing your activity and rest so you can do what you need and want to do. Manage your energy levels throughout the day by planning and pacing your activities.
By doing so, you can maintain a stable activity level and continue participating in what you enjoy. Remember to prepare yourself for the day ahead so that you have the energy you need to tackle all of your tasks.
Listen to your body
Listening to your body's signals helps manage your health. Individuals who understand their patterns of fatigue, pain, or fluctuations in energy levels can plan activities effectively, allocating energy wisely.
This increased awareness allows people with chronic illnesses to make informed decisions about their daily routines, helping them avoid triggers and adopt lifestyle modifications that can positively affect their well-being.
Stay active
Your body is experiencing changes, but one thing that hasn’t changed is your need for exercise. Over time, regular exercise can have enormous health benefits in addition to helping you manage your scleroderma. Keeping yourself healthy provides a stronger foundation for managing scleroderma.
In addition to “standard” exercises, it is vital to add stretching exercises. Daily range-of-motion/stretching exercises for fingers and other joints must be started early in the course of the disease before motion becomes limited.
Rest and relax more
Adequate rest is essential for managing common scleroderma symptoms, including pain, fatigue, sleep issues, and stress. Rest allows the body to repair, regenerate, and conserve energy.
Consistent and quality rest is linked to improved mental health. It provides a crucial foundation for coping with the emotional toll that often accompanies chronic illnesses.
Recognizing the importance of rest is crucial in managing one's overall health, having a better quality of life, and being more resilient.
Keep open communication with family, friends and others
One of the most common concerns of people with scleroderma is that people close to them without scleroderma do not understand what they are going through. This can be terribly frustrating and a source of misunderstanding or conflict.
Remember, a person without scleroderma may never fully understand what it is like to live with scleroderma. This perspective reflects the reality that scleroderma is a complex disease that is difficult to understand. It also reminds the person living with scleroderma that they cannot assume their family or friends will know how they feel.
Modify your activities
Most people in our society would say they are too busy and tired, but you are different. Your disease symptoms really affect your day-to-day energy. Simplifying your life becomes even more critical when you have scleroderma because you tire more quickly and need to manage your energy. It is harder to "push through" the fatigue to get things done than it was before your diagnosis.
To make the most of your available energy, reviewing all your activities and removing any unnecessary tasks is beneficial. By pruning these activities, you can focus on the most important tasks and do things you need to and enjoy doing.
Talk To Your Doctor
Talking with your healthcare provider can help you take an active role in managing your health. Effective communication with your healthcare team is essential for making informed decisions.
It is critical to be honest and upfront about your symptoms, even if you feel embarrassed or shy. Speak openly with your doctor or healthcare provider and ask questions to fully understand your diagnosis, treatment, and management plan.
Click the link below to learn about general strategies for talking to your doctor about your health and well-being and any health concerns you may have.