Systemic sclerosis (scleroderma)Refer

• Nifedipine SR (Raynaud phenomenon), Pantoprazole (reflux)

• Screen lungs and heart: HRCT and PFT with DLCO at diagnosis; PFT and echo yearly (lung fibrosis, pulmonary hypertension) (EULAR 2023)

First visit

• ANA, anti-Scl-70, anti-centromere — Diagnosis and subtype.
• Creatinine, urine routine, BP — Kidney crisis risk.
• PFT with DLCO and HRCT — Lung fibrosis.
• Echocardiography — Pulmonary hypertension.

Only if indicated

• Anti-RNA polymerase III — Rapid skin spread (high kidney crisis risk).
• Upper GI endoscopy — Reflux or difficulty swallowing.

Follow-up and monitoring

• PFT and echo yearly — Screening for lung and heart involvement.
• BP at every visit — Kidney crisis.