What are the symptoms of scleroderma?

Many people may suddenly find that their skin in a certain part has hardened when they wake up in the morning, which is commonly known as scleroderma. There are many reasons for scleroderma, such as stenosis or occlusion of the blood vessel lumen, or it may be due to autoimmune abnormalities. Once a person has this symptom, he should pay attention, because this disease may also cause some other diseases, such as joint pain and muscle pain, and may also cause the esophagus to harden, causing difficulty in swallowing, and abdominal pain, diarrhea and constipation. Here are some symptoms of scleroderma.

1. Raynaud's phenomenon

When the patient is cold or nervous, his hands and feet suddenly become cold, and the fingertips (toes) become pale and then turn purple. 10 to 15 minutes after the external stimulation ends, vasospasm recovers and the color of the finger (toe) tips returns to normal, appearing red or mottled. This change is called paroxysmal vasospasm (Raynaud's phenomenon). Cold-induced pallor may also occur in extremities such as the tip of the nose, tongue, lips, and earlobes.

2. Skin

In the early stage of the disease (edema stage), the skin shows mild redness and swelling. Some patients have erythema, itching and edema. The early finger edema stage can last for a long time. The skin changes stop at the distal end of the upper limbs and can also spread to the forearms, chest, abdomen, back and face. In diffuse scleroderma, the skin becomes extensively hardened with increased or decreased pigmentation, giving the skin a salt and pepper texture. As the disease progresses, the skin becomes taut and shiny, normal wrinkles and skin folds disappear, and the facial skin becomes thin and expressionless. The lips are thin and tight, mouth opening is restricted, and systemic melanin appears simultaneously, or even earlier in some cases. Patchy capillary dilation and subcutaneous calcification may occur on the fingers, face, lips, tongue, and forearms, most commonly on the fingertips. They range from small spots to large masses, covering the knees, elbows, or other most prominent parts. Calcification and telangiectasia are often more pronounced in patients with CREST syndrome. When scleroderma progresses to the sclerosis stage, the skin becomes thicker and the dryness of the skin causes itching. This stage is progressive and lasts for 1 to 3 years or longer. Finally, the inflammation and fibrosis stop and the disease enters the atrophy stage. The skin shrinks and becomes thinner, and the fibrotic tissue is tightly attached to the subcutaneous tissue and is not easy to pinch with the hands. Bone ulcers may occur at sites of flexion contracture, such as near the joints of the fingers or toes. In the later stages of atrophy, the skin in some areas gradually softens and can return to normal skin, especially the skin on the trunk and proximal limbs.

3. Muscles and bones

Nonspecific muscle and bone symptoms such as arthralgia and myalgia are the earliest manifestations of scleroderma. Sometimes there is obvious arthritis, but the pain and stiffness in the joints are always more serious than the objective signs of inflammation. The patient's muscle atrophy is caused by disuse, which is the result of limited joint movement due to involvement of the skin, joints, and tendons.

4. Lungs

Impaired lung function is common in scleroderma, but clinical symptoms are often not very obvious until the late stage of the disease, when lung involvement can become the cause of death for patients. Common clinical symptoms are shortness of breath after exertion (exertional dyspnea) and dry cough after exertion, which generally do not cause chest pain. Chest pain in people with scleroderma is often due to muscle inflammation, reflux esophagitis, pleurisy, or pericarditis. Pulmonary vascular disease caused by fibrosing alveolitis progressing to pulmonary interstitial fibrosis or vascular intimal fibrosis, as well as smooth muscle hyperplasia, can damage the ventilation function of the lungs.

5. Gastrointestinal tract

Patients may experience narrowing of the mouth, dry mucosa, difficulty chewing due to periodontal disease, tooth loss, and malnutrition. Acid reflux, heartburn, and a burning sensation behind the breastbone are the most common symptoms of scleroderma. If reflux esophagitis persists, it may lead to bleeding, ulcers, strictures, and Barrett's esophagus, which can easily turn into esophageal cancer. The cause of concurrent reflux esophagitis is related to excessive collagen fiber deposition and fibrosis in the esophageal submucosal and muscular layer, which leads to esophageal motility dysfunction, decreased lower esophageal sphincter pressure, and decreased gastric emptying ability. Prolonged gastric emptying time can not only aggravate gastroesophageal reflux, but also cause patients to experience indigestion symptoms such as upper abdominal distension and belching.