Differentiating Scleroderma from other diseases: Difference between revisions
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* Anti-centromere antibody | * Anti-centromere antibody | ||
* Antinuclear antibody (ANA) | * Antinuclear antibody (ANA) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Nailfold microvascular changes | * Anemia | ||
* Elevated creatinine level | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Nailfold microvascular changes | |||
| style="background: #F5F5F5; padding: 5px;" |Chest CT showing evidence of pulmonary fibrosis | | style="background: #F5F5F5; padding: 5px;" |Chest CT showing evidence of pulmonary fibrosis | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Interstitial lung disease | * Nailfold microvascular changes | ||
* Dilated capillary loops | |||
* Microhemmorhages | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Interstitial lung disease | |||
* Pulmonary hypertension | |||
* Calcinosis | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Diffuse cutaneous systemic sclerosis | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Diffuse cutaneous systemic sclerosis | ||
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| +/- | | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Anti-Scl-70 antibody | * Anti-topoisomerase-I (Scl-70) antibody | ||
* Antinuclear antibody (ANA) | * Antinuclear antibody (ANA) | ||
* Anti-RNA polymerase III antibody | * Anti-RNA polymerase III antibody | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Nailfold microvascular changes | * Anemia | ||
* Elevated creatinine level | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Nailfold microvascular changes | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nailfold microvascular changes | |||
* Dilated capillary loops | |||
* Microhemmorhages | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Interstitial lung disease | |||
* Pulmonary hypertension | |||
* Scleroderma renal crisis | |||
|- | |- | ||
| rowspan="6" style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic diseases | | rowspan="6" style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic diseases | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Scleroderma overlap syndromes<ref name="pmid20477023">{{cite journal |vauthors=Satoh M, Chan EK, Sobel ES, Kimpel DL, Yamasaki Y, Narain S, Mansoor R, Reeves WH |title=Clinical implication of autoantibodies in patients with systemic rheumatic diseases |journal=Expert Rev Clin Immunol |volume=3 |issue=5 |pages=721–38 |date=September 2007 |pmid=20477023 |doi=10.1586/1744666X.3.5.721 |url=}}</ref><ref name="pmid24389298">{{cite journal |vauthors=Moinzadeh P, Aberer E, Ahmadi-Simab K, Blank N, Distler JH, Fierlbeck G, Genth E, Guenther C, Hein R, Henes J, Herich L, Herrgott I, Koetter I, Kreuter A, Krieg T, Kuhr K, Lorenz HM, Meier F, Melchers I, Mensing H, Mueller-Ladner U, Pfeiffer C, Riemekasten G, Sárdy M, Schmalzing M, Sunderkoetter C, Susok L, Tarner IH, Vaith P, Worm M, Wozel G, Zeidler G, Hunzelmann N |title=Disease progression in systemic sclerosis-overlap syndrome is significantly different from limited and diffuse cutaneous systemic sclerosis |journal=Ann. Rheum. Dis. |volume=74 |issue=4 |pages=730–7 |date=April 2015 |pmid=24389298 |pmc=4392314 |doi=10.1136/annrheumdis-2013-204487 |url=}}</ref><ref name="pmid27126733">{{cite journal |vauthors=Foocharoen C, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R |title=Clinical characteristics of scleroderma overlap syndromes: comparisons with pure scleroderma |journal=Int J Rheum Dis |volume=19 |issue=9 |pages=913–23 |date=September 2016 |pmid=27126733 |doi=10.1111/1756-185X.12884 |url=}}</ref> | | rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Scleroderma overlap syndromes<ref name="pmid20477023">{{cite journal |vauthors=Satoh M, Chan EK, Sobel ES, Kimpel DL, Yamasaki Y, Narain S, Mansoor R, Reeves WH |title=Clinical implication of autoantibodies in patients with systemic rheumatic diseases |journal=Expert Rev Clin Immunol |volume=3 |issue=5 |pages=721–38 |date=September 2007 |pmid=20477023 |doi=10.1586/1744666X.3.5.721 |url=}}</ref><ref name="pmid24389298">{{cite journal |vauthors=Moinzadeh P, Aberer E, Ahmadi-Simab K, Blank N, Distler JH, Fierlbeck G, Genth E, Guenther C, Hein R, Henes J, Herich L, Herrgott I, Koetter I, Kreuter A, Krieg T, Kuhr K, Lorenz HM, Meier F, Melchers I, Mensing H, Mueller-Ladner U, Pfeiffer C, Riemekasten G, Sárdy M, Schmalzing M, Sunderkoetter C, Susok L, Tarner IH, Vaith P, Worm M, Wozel G, Zeidler G, Hunzelmann N |title=Disease progression in systemic sclerosis-overlap syndrome is significantly different from limited and diffuse cutaneous systemic sclerosis |journal=Ann. Rheum. Dis. |volume=74 |issue=4 |pages=730–7 |date=April 2015 |pmid=24389298 |pmc=4392314 |doi=10.1136/annrheumdis-2013-204487 |url=}}</ref><ref name="pmid27126733">{{cite journal |vauthors=Foocharoen C, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R |title=Clinical characteristics of scleroderma overlap syndromes: comparisons with pure scleroderma |journal=Int J Rheum Dis |volume=19 |issue=9 |pages=913–23 |date=September 2016 |pmid=27126733 |doi=10.1111/1756-185X.12884 |url=}}</ref><ref name="pmid21844148">{{cite journal |vauthors=Pakozdi A, Nihtyanova S, Moinzadeh P, Ong VH, Black CM, Denton CP |title=Clinical and serological hallmarks of systemic sclerosis overlap syndromes |journal=J. Rheumatol. |volume=38 |issue=11 |pages=2406–9 |date=November 2011 |pmid=21844148 |doi=10.3899/jrheum.101248 |url=}}</ref> | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic lupus erythematosus | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic lupus erythematosus | ||
| style="background: #F5F5F5; padding: 5px;" |Skin thickening/ rash | | style="background: #F5F5F5; padding: 5px;" |Skin thickening/ rash |
Revision as of 23:14, 19 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating X from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
- [Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
- As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
Preferred Table
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | |||||||||||||||||
Lab Findings | Imaging | Histopathology | ||||||||||||||||
Skin changes | Raynaud phenomenon | Dysphagia | Dyspnea | Edema (swelling) | Sclerodactyly | Telangiectasia | Impaired mobility | Autoantibodies | Blood indices | Nailfold video capillaroscopy | CT-scan | Imaging 3 | ||||||
Scleroderma | Limited cutaneous systemic sclerosis (CREST syndrome) | Skin thickening (induration) | + | + | +/- | +/- | + | + |
|
|
|
Chest CT showing evidence of pulmonary fibrosis |
|
| ||||
Diffuse cutaneous systemic sclerosis | Skin thickening (induration) | + | + | +/- | +/- | + | + | +/- |
|
|
|
|
| |||||
Systemic diseases | Scleredema
(Buschke's disease)[1] |
Skin thickening | - | - | - | + | - | - | + | - | - | - |
|
| ||||
Scleromyxedema
(lichen myxedematosus) |
Fibroblast proliferation in the dermis | |||||||||||||||||
Amyloidosis | ||||||||||||||||||
Eosinophilic fasciitis | + | Eosinophilia (peripheral blood smear) | ||||||||||||||||
Chronic graft-versus-host disease | ||||||||||||||||||
Drug induced scleroderma | ||||||||||||||||||
Scleroderma overlap syndromes[2][3][4][5] | Systemic lupus erythematosus | Skin thickening/ rash | + | + | +/- | +/- | + | + | +/- |
|
|
Inflammation at the dermal-epidermal junction |
| |||||
Polymyositis | Skin thickening/ rash | + | + | +/- | +/- | + | + | +/- |
|
|
|
Symmetric proximal muscle weakness | ||||||
Rheumatoid arthritis | Skin thickening/ rash | + | + | +/- | +/- | + | + | +/- |
|
|
Inflammation at the dermal-epidermal junction | Clinical findings that suggest rheumatoid arthritis (RA) but do not fulfill the ACR criteria for RA | ||||||
Endocrine disorders | Diabetes mellitus (diabetic cheiroarthropathy) | |||||||||||||||||
Myxedema due to hypothyroidism | ||||||||||||||||||
POEMS syndrome | ||||||||||||||||||
Renal diseases | Nephrogenic systemic fibrosis |
References
- ↑ Rongioletti F, Kaiser F, Cinotti E, Metze D, Battistella M, Calzavara-Pinton PG, Damevska K, Girolomoni G, André J, Perrot JL, Kempf W, Cavelier-Balloy B (December 2015). "Scleredema. A multicentre study of characteristics, comorbidities, course and therapy in 44 patients". J Eur Acad Dermatol Venereol. 29 (12): 2399–404. doi:10.1111/jdv.13272. PMID 26304054.
- ↑ Satoh M, Chan EK, Sobel ES, Kimpel DL, Yamasaki Y, Narain S, Mansoor R, Reeves WH (September 2007). "Clinical implication of autoantibodies in patients with systemic rheumatic diseases". Expert Rev Clin Immunol. 3 (5): 721–38. doi:10.1586/1744666X.3.5.721. PMID 20477023.
- ↑ Moinzadeh P, Aberer E, Ahmadi-Simab K, Blank N, Distler JH, Fierlbeck G, Genth E, Guenther C, Hein R, Henes J, Herich L, Herrgott I, Koetter I, Kreuter A, Krieg T, Kuhr K, Lorenz HM, Meier F, Melchers I, Mensing H, Mueller-Ladner U, Pfeiffer C, Riemekasten G, Sárdy M, Schmalzing M, Sunderkoetter C, Susok L, Tarner IH, Vaith P, Worm M, Wozel G, Zeidler G, Hunzelmann N (April 2015). "Disease progression in systemic sclerosis-overlap syndrome is significantly different from limited and diffuse cutaneous systemic sclerosis". Ann. Rheum. Dis. 74 (4): 730–7. doi:10.1136/annrheumdis-2013-204487. PMC 4392314. PMID 24389298.
- ↑ Foocharoen C, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R (September 2016). "Clinical characteristics of scleroderma overlap syndromes: comparisons with pure scleroderma". Int J Rheum Dis. 19 (9): 913–23. doi:10.1111/1756-185X.12884. PMID 27126733.
- ↑ Pakozdi A, Nihtyanova S, Moinzadeh P, Ong VH, Black CM, Denton CP (November 2011). "Clinical and serological hallmarks of systemic sclerosis overlap syndromes". J. Rheumatol. 38 (11): 2406–9. doi:10.3899/jrheum.101248. PMID 21844148.