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 ¹ (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 ¹ (Lazzaroni et al., 2023).
• Digital ulcers and pitting scars: These result from microvascular damage and are important clinical clues ¹ (Saketkoo et al., 2014).
• Telangiectasia: Small dilated blood vessels visible on the skin surface, often on the face and hands, are common ¹ (Lazzaroni et al., 2023).
• Calcinosis: Subcutaneous calcium deposits may be palpable or visible, particularly in limited cutaneous forms ¹ (Lazzaroni et al., 2023).
• Systemic symptoms: Fatigue, arthralgia, and myalgia may be present early and should raise suspicion ¹ (Saketkoo et al., 2014).
• Gastrointestinal symptoms: Dysphagia, reflux, and bloating can be early manifestations due to oesophageal involvement ¹ (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 ¹ (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 ¹ (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).