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Early Systemic Sclerosis — RACP Adult Medicine MCQ

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ModerateRheumatologyEarly Systemic SclerosisRACP Adult Medicine

A 45-year-old woman presents with Raynaud phenomenon affecting her fingers. She has no other symptoms. ANA is positive at 1:160 with a nucleolar pattern. Nailfold capillaroscopy shows dilated capillary loops and microhaemorrhages. What is the most likely evolving diagnosis?

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Correct answer: C — Systemic sclerosis

A nucleolar ANA pattern with abnormal nailfold capillaroscopy (dilated loops, microhaemorrhages, avascular areas) in a patient with Raynaud phenomenon is highly predictive of evolving systemic sclerosis (scleroderma), even before other features develop. Nailfold capillaroscopy is now an established early diagnostic tool incorporated into the ACR/EULAR 2013 SSc classification criteria. Annual screening for ILD, PAH, and renal crisis should commence.

Reference: eTG – 2025 – Rheumatology; ACR/EULAR – 2013 – SSc Classification Criteria