Differentiating Scleroderma from other diseases: Difference between revisions
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Raynaud phenomenon | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Raynaud phenomenon | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia/ heart burn | ||
!Dyspnea | !Dyspnea | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Edema (swelling) | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Edema (swelling) | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3 | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3 | ||
|- | |- | ||
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Scleroderma | | rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Scleroderma<ref name="pmid3361530">{{cite journal |vauthors=LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F |title=Scleroderma (systemic sclerosis): classification, subsets and pathogenesis |journal=J. Rheumatol. |volume=15 |issue=2 |pages=202–5 |date=February 1988 |pmid=3361530 |doi= |url=}}</ref><ref name="pmid8340733">{{cite journal |vauthors=Black CM |title=Scleroderma--clinical aspects |journal=J. Intern. Med. |volume=234 |issue=2 |pages=115–8 |date=August 1993 |pmid=8340733 |doi= |url=}}</ref> | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Limited cutaneous systemic sclerosis (CREST syndrome) | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Limited cutaneous systemic sclerosis (CREST syndrome) | ||
| style="background: #F5F5F5; padding: 5px;" |Skin thickening (induration) | | style="background: #F5F5F5; padding: 5px;" |Skin thickening (induration) | ||
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| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| | |<nowiki>+/-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* 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;" | | ||
* Anemia | |||
* Elevated creatinine level | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| 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;" | | |||
* 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> | | 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 | ||
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* Anti-RNA polymerase III antibody | * Anti-RNA polymerase III antibody | ||
* Antinuclear antibody (ANA) | * Antinuclear antibody (ANA) | ||
* Anti- | * Anti-Smith antibody | ||
* Anti-dsDNA antibody | * Anti-dsDNA antibody | ||
* Antiphospholipid antibody | * Antiphospholipid antibody | ||
* Anti-Ro52 | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Decreased C3, C4 and CH50 | |||
* Anemia | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Malar (butterfly) rash | |||
* Arthritis | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Polymyositis | ||
| style="background: #F5F5F5; padding: 5px;" |Skin thickening/ rash | | style="background: #F5F5F5; padding: 5px;" |Skin thickening/ rash | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
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* Anti-RNA polymerase III antibody | * Anti-RNA polymerase III antibody | ||
* Antinuclear antibody (ANA) | * Antinuclear antibody (ANA) | ||
| style="background: #F5F5F5; padding: 5px;" |Elevated creatinine kinase | * Anti-Jo-1 antibody | ||
* Anti-SRP antibody | |||
* Anti-Mi-2 antibody | |||
* Anti-Ro52 | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Elevated creatinine kinase | |||
* Aldolase | |||
* Anemia | |||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Inflammation at the dermal-epidermal junction | |||
* Atrophy of the epidermis | |||
* Perivascular infiltrate in the dermis | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Symmetric proximal muscle weakness | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Rheumatoid arthritis | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Rheumatoid arthritis | ||
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* Rheumatoid factor (RA) +ve | * Rheumatoid factor (RA) +ve | ||
* Anti-CCP antibody | * Anti-CCP antibody | ||
| style="background: #F5F5F5; padding: 5px;" |Elevated ESR | * Anti-Ro52 | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Elevated ESR | |||
* Anemia | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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|- | |- | ||
| rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Endocrine disorders | | rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Endocrine disorders | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Diabetes mellitus (diabetic cheiroarthropathy) | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Diabetes mellitus (diabetic cheiroarthropathy)<ref name="pmid6753855">{{cite journal |vauthors=Seibold JR |title=Digital sclerosis in children with insulin-dependent diabetes mellitus |journal=Arthritis Rheum. |volume=25 |issue=11 |pages=1357–61 |date=November 1982 |pmid=6753855 |doi= |url=}}</ref><ref name="pmid8485952">{{cite journal |vauthors=Jelinek JE |title=The skin in diabetes |journal=Diabet. Med. |volume=10 |issue=3 |pages=201–13 |date=April 1993 |pmid=8485952 |doi= |url=}}</ref> | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Skin thickening | |||
* Waxy skin | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|<nowiki>-</nowiki> | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|<nowiki>+</nowiki> | |||
| 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;" | | ||
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| 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;" |Long standing type I diabetes | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Myxedema due to hypothyroidism | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Myxedema due to hypothyroidism |
Revision as of 23:51, 19 April 2018
Scleroderma Microchapters |
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Differentiating Scleroderma from other diseases On the Web |
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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/ heart burn | Dyspnea | Edema (swelling) | Sclerodactyly | Telangiectasia | Impaired mobility | Autoantibodies | Blood indices | Nailfold video capillaroscopy | CT-scan | Imaging 3 | ||||||
Scleroderma[1][2] | 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)[3] |
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[4][5][6][7] | 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)[8][9] |
|
- | - | - | - | + | - | + | - | Long standing type I diabetes | |||||||
Myxedema due to hypothyroidism | ||||||||||||||||||
POEMS syndrome | ||||||||||||||||||
Renal diseases | Nephrogenic systemic fibrosis |
References
- ↑ LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F (February 1988). "Scleroderma (systemic sclerosis): classification, subsets and pathogenesis". J. Rheumatol. 15 (2): 202–5. PMID 3361530.
- ↑ Black CM (August 1993). "Scleroderma--clinical aspects". J. Intern. Med. 234 (2): 115–8. PMID 8340733.
- ↑ 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.
- ↑ Seibold JR (November 1982). "Digital sclerosis in children with insulin-dependent diabetes mellitus". Arthritis Rheum. 25 (11): 1357–61. PMID 6753855.
- ↑ Jelinek JE (April 1993). "The skin in diabetes". Diabet. Med. 10 (3): 201–13. PMID 8485952.