How is scleroderma diagnosed?
Many scleroderma symptoms resemble the symptoms of a number of conditions, which means it can take longer to find out if scleroderma is the cause or which of the different types of scleroderma is present. Diagnosing scleroderma becomes a little easier if some of the primary physical symptoms or signs are present, such as Raynaud’s phenomenon or skin that appears to suddenly become puffy, swollen or thick.
There is no single test for scleroderma. It is a clinical diagnosis that requires a thorough exam and history by the doctor. The doctor will start by asking questions about symptoms and previous medical history. He or she will also do a physical exam and may order a biopsy to look at a small sample of the affected skin under a microscope. He or she may also order urine, blood and other tests to see if any internal organs have been affected.
Specific Tests for Scleroderma
One of the most important tests that a physician performs is a physical examination. A rheumatologist will be able to assess the skin for skin tightening or swelling that is typically seen in patients with scleroderma. As discussed above, patients with scleroderma who have Raynaud’s phenomenon will have characteristic features seen on nailfold capillaroscopy, a simple noninvasive test that looks at the skin near the base of the fingernail with a magnifier to determine if there is capillary (small blood vessels in the skin) loss or distortion such as dilatation.
After a thorough examination, the doctor may also order an antibody nuclear (ANA) test, which will let them know if any autoantibodies (blood proteins) are in the blood. However, because our bodies develop antibodies for other reasons, the results of an ANA test by itself don’t determine a diagnosis of scleroderma. It is important to remember that scleroderma is a clinical diagnosis that takes into account all factors, including the physical examination and all symptoms. A blood test alone cannot diagnose scleroderma. Depending on the clinical situation, additional tests may be done, such as:
- Pulmonary function tests or breathing tests to measure how well the lungs are working.
- CT chest scan may also be ordered to evaluate the extent of lung involvement.
- Electrocardiogram (EKG or ECG) to see if there are changes in the heart muscle tissue due to scleroderma. An EKG/ECG records the electrical activity of the heart, shows abnormal rhythms and detects any damage.
- Echocardiogram to look at the structure and function of the heart. It uses sound waves to take pictures of the heart and valves.
- X-rays or special imaging to show any changes in the bones or soft tissues caused by scleroderma. It uses a small amount of radiation to take pictures of internal tissues, bones and organs.
- Motility studies to assess for gastrointestinal dysmotility.
After You’ve Been Diagnosed with Scleroderma
Once a diagnosis of scleroderma is determined then the type of scleroderma is defined to help determine the best treatment plan that is specific to the system and organ involvement. This plan will take into account the severity and activity of the particular type of scleroderma. Many times scleroderma is mild and not active and treatment is supportive. If it is serious and active there are many options to manage the specific situation.