What are the eye changes in systemic sclerosis??*

– start from outside… eyelid stiffness, eyelid telengiectasis

– cataracts

– glaucoma

– keratoconjuctivitis sicca

– optic neuropathy

– orbital fat atrophy

What are the git findings ??

Remember  findings from top to bottom, you will never forget

1. Start from mouth i.e microstomia & icrocheilia ( this is dec in mouth width)
2. Xerostomia
3. Then comes teeth, enamel is damaged
4. Dysphagia/ regurg
5. Gastroparesis
6. Small bowel dysmotility
7. Large bowel diverticulosis
8. Ano rectum… this is 2nd most common site affected after oesophagus, internal anal sphincter is involved

What are the bone changes in systemic sclerosis ?*

– phalangeal resorption

– erosive arthropathy ( pestle and mortar deformity)

– flexion deformities

– acro osteolysis

– joint space narrowing

-severe resorption of 1st carpometacarpal joint with radial subluxation and this is characteristic finding…

– calcinosis

 What are soft tissue changes ?*

– subcutaneous and periarticular calcification

– atrophy of finger tips

What are the ecg findings in systemic sclerosis ?*

 ST-T changes

– conduction abnormalities like LBBB, first degree AV block, prolonged QT, SVT, VT

 What are the echo findings in systemic sclerosis?

*

diastolic dysfunction

valvular regurgitation

Right ventricular pathology

DETECT study

A non invasive method to tell us when to go for invasive right heart catheterization.

🔅Step 1

Calculate a score by measuring 6 parameters

-fvc predicted /dlco predicted

-telengiectasia yes or no

– anti centromere antibody yes or no

– right axis deviation on ecg yes or no

– serum urate level

– pro bnp level

( easy to remember 3 have yes or no, and 3 are values)

If the score is more than 300 then go for echo

🔅Step 2

You see right atrium area in cm2, 

TRJ (tricuspid regurgitant jet) velocity in m/s and step 1 total risk score

If its more than 35, then right heart catheterization is recommended..

HSCT considered in SSc when 👇🏻

Disease is rapidly progressive

Severe visceral involvement esp pulmonary involvement

Unresponsive to treatment

🔰 IMPORTANT 🔰

Systemic sclerosis is a very imp long case which always comes in exam, isolated or as a part of MCTD.

So its imp to know every aspect of it.

Like other long n short cases, examiner already makes his mind in the first 10mins after listening to ua history so its critically imp to have a firm grip over history taking and then on the examination.

Ua body language says it all about how many patients u have examined.

So practice as much as u can, ofcourse with a timer on ua bedside coz without time management even the best candidates face the bitterness if failure.

Happy learning😊

Dermatomyositis