Keyword for Investigation, Referral to specialist and Writing hospital records by Systemic Sclerosis 5/5 (1)

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ICD-10: M34.0 (diffuse form) M 34.1 (Limited Crest Form)

Diagnosis is based on

  • Disease history
  • Medical Examination Findings
  • Antibodies

Disease history

Time of symptom debut (Raynaud's phenomenon and other symptoms) and for diagnosis

* (Star) marks the symptoms and research findings that are included in ACR-EULAR Criteria (2013):

Symptoms

Clinical examination

Supplementary medical investigations

Radiological examinations

  • X-ray examination of the esophagus (dynamic with ingestion of contrast agent) or manometry (dysmotility, stenoses, reflux)
  • CT examination / HRCT of lungs (milk glass, fibrosis or extended pulmonary artery (more than 3,5cm) at suspected Pulmonary hypertension)
    • More than 20% lung tissue infection suggests serious lung involvement
  • MRI of the heart
    • Can detect fibrosis in the heart muscle

Lung function tests

  • Lung function tests (FEV1, FVC, DLCO% of expected)
    • Severe lung manifestation: FVC less than 70% and CT examination show more than 20% attacked lung tissue. Similarly, if FVC and DLCO fall by 10% and 15%, respectively, each year

Capillaroscopy

  • Mega capillaries, bleeding, "bushy" capillaries

6-minute walk test

  • The distance traveled during the 6 minute maximum, but even times
  • Can be done in a corridor with a measured distance of trained health personnel with emergency medical access
  • Registration of oxygen saturation and Borg's Dyspne Index (scale 0-10) before and immediately after the test
  • Reference: ATS statement: guidelines for the six-minute walk test

Echocardiography

Cardiac examination

Blood tests

Follow-up for systemic sclerosis

Uncertain diagnosis?

Norwegian Directorate of Health (Supervisor for referrals)


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