Imaging in early diagnosis of systemic sclerosis. Clinical case report

Abstract

Systemic sclerosis is a disease of connective tissue where there is an overproduction of extracellular matrix, which causes fibrosis in the skin and other organs. It is characterized by vascular dysfunction and alterations in the microvasculature. The clinical manifestations can be very
variable during their evolution, integrating these clinical data with the use of new technologies such as capillaroscopy and ultrasound can detect the disease early without the progression of the disease .The present case report corresponds to a 65 years old female patient, who is
referred for suspicion of polymyalgia rheumatica. After the interrogation, an asymmetric Raynaud phenomenon and pain at carpal and metacarpophalangeal level was evidenced. Ultrasound (US) was performed in those joints finding chronic synovitis associated with tenosynov itis, and early scleroderma pattern in nailfold capillaroscopy was also shown. The immunological profile was requested obtaining positive antibodies (SCL 70 and ANAs). Subsequently B lines were found in the pulmonary US. For all of the above, the diagnosis of Systemic Sclerosis (SS) was reached and treatment was started. We conclude that the support of different imaging methods such as musculoskeletal ultrasound and nailfold capillaroscopy are fundamental for the diagnosis of early SS.