What are the key clinical features to consider when diagnosing scleroderma in a primary care setting?

Key clinical features to consider when diagnosing scleroderma in primary care include:

• Raynaud's phenomenon: This is often the earliest and most common presenting symptom, characterised by episodic digital pallor, cyanosis, and erythema triggered by cold or stress NICE CKS Saketkoo et al. 2014.
• Skin changes: Look for skin thickening and tightening, especially starting at the fingers and hands (sclerodactyly), which may progress proximally. Early skin oedema and later fibrosis are typical NICE CKS Lazzaroni et al. 2023.
• Digital ulcers and pitting scars: These result from microvascular damage and are important clinical clues NICE CKS Saketkoo et al. 2014.
• Telangiectasia: Small dilated blood vessels visible on the skin surface, often on the face and hands, are common NICE CKS Lazzaroni et al. 2023.
• Calcinosis: Subcutaneous calcium deposits may be palpable or visible, particularly in limited cutaneous forms NICE CKS Lazzaroni et al. 2023.
• Systemic symptoms: Fatigue, arthralgia, and myalgia may be present early and should raise suspicion NICE CKS Saketkoo et al. 2014.
• Gastrointestinal symptoms: Dysphagia, reflux, and bloating can be early manifestations due to oesophageal involvement NICE CKS Lazzaroni et al. 2023.
• Respiratory symptoms: Although less common in primary care presentation, early breathlessness or cough may indicate lung involvement and warrant further assessment NICE CKS Saketkoo et al. 2014.

In primary care, recognising the constellation of these features, especially Raynaud's phenomenon combined with skin changes and digital ulcers, is critical for early diagnosis and referral NICE CKS Saketkoo et al. 2014. Recent literature emphasises the importance of early recognition of subtle skin and vascular changes to improve outcomes Lazzaroni et al. 2023.