Kalinga Bommanakatte Eranaik1, Uday Subhas Bande2, Basavaraj Devendrappa Baligar3, Varun Bhaktarahalli Renukappa4, Amogh Laxman Jambagi5
PRESENTATION OF CASE
A 25-year-old female presented to outpatient department with complaints of pain in small joints of hand and on exposure to cold water since 2 months. Patient was nonsmoker and nonalcoholic. Patient was previously treated with analgesics with minimum improvement in symptoms. She noticed small ulcers in hand and foot since 1 month.
Examination revealed painful sclerodactyly involving all fingers solitary ulcer was noted in foot and there was restricted mouth opening, rest of systemic examination was within normal limits.
Clinical diagnosis of systemic sclerosis was made and patient was evaluated with routine and specific investigations.
Figure 1. Sclerodactyly/Raynaud's Phenomenon
Raynaud’s phenomenon is one of the earliest manifestation of systemic sclerosis in patients who present early.1 It is seen that the incidence of systemic sclerosis is less in Asian group when compared to European population.2 The incidence is more common among females and is seen around 4th to 5thdecade. However, certain associations are found with systemic sclerosis, which make the disease manifest early and behave more aggressively. One such association is between systemic sclerosis and Antiphospholipid Antibody (APLA).
It is seen in several studies that APLA is positive in about 10% of patients with systemic sclerosis.3 These patients have a tendency to develop ulcers in fingers early in the course of their illness as compared to APLA negative patients.4 Further higher titre of APLA correlate with the severity of pulmonary complication in systemic sclerosis,5 though this is not consistent in all studies. Thus, screening for APLA for all patients is necessary is systemic sclerosis.