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a STudy PubliShEd in CLINICAL RHEUMATOLOGY Found ThaT connEcTiVE TiSSuE MaSSagE, coMbinEd wiTh JoinT ManiPulaTion, iMProVEd MobiliTy in a grouP oF PaTiEnTS wiTh SclErodErMa. Additional Resources Ehrlich S. Scleroderma. university of Maryland Medical center (uMMc), 2009. available at www.umm.edu/ altmed/articles/scleroderma-000147. htm (accessed october 2009). Khanna d. et al. digestive system (gut, gastro-intestinal) involvement in scleroderma. Scleroderma Foundation. available at www. scleroderma.org/medical/gastro_ articles/khanna_furst_2004_4. shtm (accessed october 2009). what is scleroderma? Scleroderma Foundation. available at www. scleroderma.org/medical/overview. shtm (accessed october 2009). your questions answered! crEST syndrome. originally published in Scleroderma Voice 4 (2004), Scleroderma Foundation. available at www.scleroderma. org/medical/crest_articles/weller_2004_4. htm (accessed october 2009). c—calcinoSiS cuTiS This refers to small calcium deposits in the skin. These can be too tiny to recognize, or of significant size, causing pain, further inflammation, and ulcerations. r—raynaud'S PhEnoMEnon This describes periodic bouts of extreme vascular contractions in the hands or feet. The skin turns white with lack of blood flow, then blue with longer-term oxygen deprivation, and finally red as the blood flow is returned. Raynaud's phenomenon is not synonymous with Raynaud's disease, which is a free-standing condition often related to cold exposure and overuse. Raynaud's phenomenon, by contrast, is always associated with autoimmune disease and tends to be more severe and carry the risk of complications like tissue damage and even gangrene. the disease itself, but it may also be the resulting irritation from aspirated food and liquid due to esophageal reflux. c—conTracTurES oF digiTal JoinTS Contractures are permanently shortened muscles due, in this case, to the loss of function at the nearby joints. This comes about because the skin on the hands is so tight the fingers can't move. d—dErMal ThicKEning ProxiMal To wriSTS The hands of a patient with scleroderma are often involved; when the thickened, hardened skin occurs proximal to the wrists (i.e., on the trunk, neck or face) this is a more definitive sign of cutaneous systemic disease. E—ESoPhagEal dySMobiliTy A consistent experience of patients with cutaneous systemic scleroderma is problems with digestion. These challenges typically start at the proximal end of the digestive tract with esophageal dysfunction—it becomes difficult to pass food through to the stomach. It often feels lodged or stuck in the esophagus, and it may require vomiting to clear the passage. This happens because blood vessels that supply the motor nerves to the gastrointestinal tract are impaired, and the result is general peristaltic weakness. Chronic reflux (along with heartburn and the risk of esophageal cancer from ongoing irritation) is one possibility, but impaired motor nerve supply can affect the small and large intestines with generally poor smooth muscle tone and interrupted peristaltic function. S—SclErodacTyly This means hardening of the fingers. One of the hallmarks of scleroderma is patches of hardened, shiny skin, usually on the hands. The skin can become so tight that the fingers can no longer move, leading to the contractures discussed above. T—TElangiEcTaSiaS These are clusters of tiny dilated blood vessels. They are commonly called spider veins. On the skin, they are harmless, and often appear close to larger varicose veins. In patients with scleroderma, they appear on the face, especially around the mouth, and on the hands. These are unusual areas for these skin markings. GI scopes may also reveal telangiectasias in the lining of the stomach of scleroderma patients as well. This is a more serious problem, because in this location they may rupture and bleed, leading to serious anemia. OTHER SIGNS, SYMPTOMS, AND COMPLICATIONS Any type of systemic scleroderma carries a long list of possible complications. Again, not every patient is at risk for these problems, but part of good care is being watchful in order to anticipate and treat these challenges as they arise. Lung damage (including an increased risk of lung cancer) is a threat, as the delicate tissues are invested with scar tissue. This can cause pulmonary hypertension and right-sided heart failure as the heart tries to push blood through the obstructed and resistant pulmonary circuit. Sjogren's syndrome describes pathologically dry eyes and salivary glands that can lead to both eye and mouth infections. When the skin on the face is affected, tooth decay and infection is a significant issue, because the patients can't open their mouths wide enough to brush their teeth. Joint pain is common with scleroderma connect with your colleagues on massageprofessionals.com 109