Differentiating Scleroderma from other diseases
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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] |
|
- | - | - | - | + | - | + | - | 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.