Differentiating Scleroderma from other diseases: Difference between revisions
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| colspan="7" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | | colspan="7" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | ||
| | | | ||
! colspan=" | ! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings | ||
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ||
|- | |- | ||
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms''' | | colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms''' | ||
! colspan=" | ! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
|- | |- | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | |||
! colspan=" | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ||
! | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology | ||
|- | |- | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin thickening | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin thickening | ||
! 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;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |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;" |Autoantibodies | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autoantibodies | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood indices | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood indices | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nailfold video capillaroscopy | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nailfold video capillaroscopy | ||
|- | |- | ||
| 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> | | 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> | ||
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* Anemia | * Anemia | ||
* Elevated creatinine level | * Elevated creatinine level | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nailfold microvascular changes | * Nailfold microvascular changes | ||
* Chest CT showing evidence of pulmonary fibrosis | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nailfold microvascular changes | * Nailfold microvascular changes | ||
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* Anemia | * Anemia | ||
* Elevated creatinine level | * Elevated creatinine level | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nailfold microvascular changes | * Nailfold microvascular changes | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nailfold microvascular changes | * Nailfold microvascular changes | ||
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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;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* Normal epidermis | * Normal epidermis | ||
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| style="background: #F5F5F5; padding: 5px;" |Eosinophilia (peripheral blood smear) | | style="background: #F5F5F5; padding: 5px;" |Eosinophilia (peripheral blood smear) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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* Antinuclear antibody (ANA) | * Antinuclear antibody (ANA) | ||
* Anti-mitochondrial antibody | * Anti-mitochondrial antibody | ||
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* Decreased C3, C4 and CH50 | * Decreased C3, C4 and CH50 | ||
* Anemia | * Anemia | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Inflammation at the dermal-epidermal junction | | style="background: #F5F5F5; padding: 5px;" |Inflammation at the dermal-epidermal junction | ||
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* Aldolase | * Aldolase | ||
* Anemia | * 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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* Elevated ESR | * Elevated ESR | ||
* Anemia | * Anemia | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Inflammation at the dermal-epidermal junction | | style="background: #F5F5F5; padding: 5px;" |Inflammation at the dermal-epidermal junction | ||
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| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Endocrine disorders | | rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Endocrine disorders | ||
| 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> | | 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> | ||
| style="background: #F5F5F5; padding: 5px;" |+ | | style="background: #F5F5F5; padding: 5px;" | + | ||
(waxy skin) | (waxy skin) | ||
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|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| 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: #DCDCDC; padding: 5px; text-align: center;" |Myxedema due to hypothyroidism<ref name="pmid1607406">{{cite journal |vauthors=Heymann WR |title=Cutaneous manifestations of thyroid disease |journal=J. Am. Acad. Dermatol. |volume=26 |issue=6 |pages=885–902 |date=June 1992 |pmid=1607406 |doi= |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Myxedema due to hypothyroidism<ref name="pmid1607406">{{cite journal |vauthors=Heymann WR |title=Cutaneous manifestations of thyroid disease |journal=J. Am. Acad. Dermatol. |volume=26 |issue=6 |pages=885–902 |date=June 1992 |pmid=1607406 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" |+ | | style="background: #F5F5F5; padding: 5px;" | + | ||
(coarse skin) | (coarse skin) | ||
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* Anemia | * Anemia | ||
* Serum TSH | * Serum TSH | ||
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* Decreased serum albumin | * Decreased serum albumin | ||
* Decreased creatinine clearance | * Decreased creatinine clearance | ||
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Revision as of 13:45, 20 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 thickening | Raynaud phenomenon | Heart burn | Dyspnea | Edema (swelling) | Sclerodactyly | Telangiectasia | Impaired mobility | Autoantibodies | Blood indices | Nailfold video capillaroscopy | |||||
Scleroderma[1][2] | Limited cutaneous systemic sclerosis (CREST syndrome) | +
(induration) |
+ | + | +/- | +/- | + | + | +/- |
|
|
|
|
| |
Diffuse cutaneous systemic sclerosis | +
(induration) |
+ | + | +/- | +/- | + | + | +/- |
|
|
|
|
| ||
Systemic diseases | Scleredema
(Buschke's disease)[3] |
+ | - | - | - | + | - | - | + | - | - | - |
|
| |
Scleromyxedema
(lichen myxedematosus) |
Fibroblast proliferation in the dermis | ||||||||||||||
Amyloidosis | |||||||||||||||
Eosinophilic fasciitis | + | Eosinophilia (peripheral blood smear) | Skin changes present on trunk sparing extremities | ||||||||||||
Chronic graft-versus-host disease | +
(induration) |
- |
|
Occurs after allogeneic hematopoietic transplantation | |||||||||||
Drug induced scleroderma | |||||||||||||||
Scleroderma overlap syndromes[4][5][6][7] | Systemic lupus erythematosus | +
(rash) |
+ | + | +/- | +/- | + | + | +/- |
|
|
Inflammation at the dermal-epidermal junction |
| ||
Polymyositis | +
(rash) |
+ | + | +/- | +/- | + | + | +/- |
|
|
|
Symmetric proximal muscle weakness | |||
Rheumatoid arthritis | +
(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] | +
(waxy skin) |
- | - | - | - | + | - | + | - | - | Long standing type I diabetes | |||
Myxedema due to hypothyroidism[10] | +
(coarse skin) |
- | - | - | + | - | - | - |
|
|
|
Hypothyroidism | |||
Renal diseases | Nephrogenic systemic fibrosis[11] | +
(induration) |
- | - | - | + | + | - | - | - |
|
|
|
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.
- ↑ Heymann WR (June 1992). "Cutaneous manifestations of thyroid disease". J. Am. Acad. Dermatol. 26 (6): 885–902. PMID 1607406.
- ↑ Galan A, Cowper SE, Bucala R (November 2006). "Nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy)". Curr Opin Rheumatol. 18 (6): 614–7. doi:10.1097/01.bor.0000245725.94887.8d. PMID 17053507.