American Medical Association Family Medical Guide - American Medical Association [633]
Systemic scleroderma causes much more serious symptoms, including digestive symptoms such as difficulty swallowing, indigestion, and difficulty controlling bowel movements. Respiratory symptoms such as shortness of breath and a persistent dry cough can develop. If the disorder affects the heart, chest pain, abnormal heart rhythms (see page 580), or heart failure (see page 570) can occur. Damage to the kidneys can lead to high blood pressure, headaches, seizures (see page 686), infrequent urination, blood in the urine, or kidney failure (see page 816).
Diagnosis
To reach a diagnosis of scleroderma, the doctor will take a complete health history and perform a thorough physical examination, paying special attention to the appearance of the skin. The doctor will probably order a blood test to measure the level of a specific antibody produced only by people with scleroderma, which would indicate that the immune system is launching an abnormal attack against connective tissue throughout the body. To confirm the diagnosis, the doctor may recommend a biopsy, in which a sample of tissue is removed and examined under a microscope for excess collagen.
Treatment
There is no effective treatment for scleroderma, but self-help measures and medication can help relieve your symptoms and improve your quality of life. Relaxation techniques (see page 59) such as deep breathing or meditation can help you manage stress and reduce the frequency and severity of episodes. Stay warm and keep your hands and feet warm and dry to help prevent the painful constriction of the blood vessels in the fingers and toes. Your doctor may prescribe vasodilators (drugs that widen the blood vessels) and diuretics (drugs that help the body eliminate excess fluid) to improve circulation and reduce swelling in your hands and feet.
If you smoke or use other tobacco products, quit now. Chemicals in tobacco smoke can damage blood vessels and impair circulation. Smoking also lowers skin temperature, which can trigger an attack of scleroderma.
Exercise regularly to help maintain your flexibility and strength and improve your circulation. Ask your doctor to recommend some exercises that will work for you. To relieve inflammation, pain, and stiffness in your muscles and joints, your doctor may recommend over-the-counter nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen) or may prescribe a corticosteroid medication. He or she will probably also recommend physical therapy to help you retain your strength and mobility.
To relieve digestive symptoms, eat smaller, more frequent meals; avoid eating within 3 or 4 hours of bedtime; sleep with the head of your bed elevated; and take an over-the-counter antacid when you have symptoms. You should know, however, that while over-the-counter antacids can provide temporary relief of digestive symptoms such as heartburn, bloating, and indigestion, they also can mask symptoms of a more serious underlying disorder. If you use antacids, be sure to follow the instructions on the package. If you use antacids regularly, or if your symptoms persist or worsen, talk to your doctor.
For severe cases of scleroderma, doctors usually prescribe immune-suppressing drugs such as penicillamine or cyclophosphamide to relieve inflammation, reduce organ damage, and suppress the abnormal activity of the immune system.
Polymyositis and Dermatomyositis
Myositis means inflammation of the muscles. Polymyositis is a rare, chronic disorder that is characterized by inflammation of many muscles throughout the body. The disorder can occur at any age but is most common in children between ages 5 and 15 and in adults between ages 40 and 60.
Polymyositis occurs twice as often in women as in men. The cause of the disorder is unknown, but doctors