Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive skin thickening, Raynaud’s phenomenon, and symmetric inflammatory polyarthritis. Reports morning stiffness >60 minutes, digital ulcers, and difficulty with fine motor tasks. Denies recent chest pain or dyspnea.
Clinical Examination Findings
Skin: Sclerodactyly, skin tightening proximal to MCP joints, salt-and-pepper pigmentation. Musculoskeletal: Synovitis of MCP and PIP joints, limited range of motion, tendon friction rubs. Vascular: Digital pitting scars, capillary nailfold changes noted on dermoscopy.
Treatment Protocol
Initiate DMARDs (e.g., Methotrexate) for inflammatory arthritis. Calcium channel blockers for Raynaud’s. Topical emollients for skin. Consider PPI for GERD prophylaxis. Physical therapy for joint mobility and hand function.