Types of Systemic Scleroderma
Classification: Limited and Diffuse
|CREST (old name for Limited)
Limited Systemic Sclerosis
Diffuse Systemic Sclerosis
There are many methods used to categorize the various forms of scleroderma, which has brought about a confusing abundance of terms. The following categories are often found in patient literature, but use and interpretation of these categories varies quite a bit. (Also see What is Scleroderma?, Types of Scleroderma and Systemic Symptoms)
(PDF) Systemic Sclerosis. Systemic sclerosis (SSc) is a debilitating, chronic autoimmune disease that causes the body's immune system to attack its own tissue. The underlying cause is unknown and it is potentially fatal. There are two main types, limited cutaneous and diffuse cutaneous. Roche.
Classification Criteria for Systemic Sclerosis. The ACR/EULAR classification criteria for systemic sclerosis (SSc) performed better than the 1980 ACR criteria and should allow for more patients to be classified correctly as having the disease. Arthritis & Rheumatism, 3 October 2013.
There are several types of Systemic Scleroderma: CREST, Limited and Diffuse. Systemic scleroderma is also known as systemic sclerosis (SSc). It may also be referred to as Progressive Systemic Sclerosis (PSSc), or Familial Progressive Systemic Sclerosis (FPSSc).
Systemic scleroderma may affect the skin, blood vessels, and/or internal organs. When it affects the skin, it can cause the skin—most commonly on the hands and/or face—to harden. With the blood vessels, it can cause Raynaud's. When it affects the internal organs, it may cause disability or even death. (Also see Types of Scleroderma, and Systemic Scleroderma Symptoms)
Psoriasis and concomitant fibrosing disorders: Lichen sclerosus, morphea, and systemic sclerosis. In this population, a predisposition toward autoimmunity is seen as 38.5% of patients had a personal history of a third concomitant autoimmune disease, in addition to psoriasis and fibrosing disorder, whereas 42.3% reported a history of a first-degree relative with an autoimmune disease. Journal of the American Academy of Dermatology Volume 67, Issue 5 , Pages 1079-1083, November 2012. (Also see Psoriasis, Lichen Sclerosus, Morphea, and Multiple Autoimmune Syndrome)
Early- versus late-onset systemic sclerosis: differences in clinical presentation and outcome in 1037 patients. Peak age at onset of systemic sclerosis (SSc) is between 20 and 50 years, although SSc is also described in both young and elderly patients. We conducted the present study to determine if age at disease onset modulates the clinical characteristics and outcome of SSc patients. PubMed, Medicine (Baltimore). 2014 Mar;93(2):73-81. (Also see Prognosis and Mortality: Age at Onset)
The degree of skin involvement identifies distinct lung disease outcomes and survival in systemic sclerosis (SSc). These data suggest that the current classification subdividing SSc into limited and diffuse cutaneous subtypes misclassifies an intermediate group of patients exhibiting unique autoantibody profile, disease course and clinical outcomes. PubMed, Ann Rheum Dis, 2013 Apr 20. (Also see Classification of Systemic Sclerosis)
Diagnosis and Classification of Systemic Sclerosis (SSc). Patients with limited SSc (lSSc) must have Raynaud's phenomenon and SSc specific nail fold capillary changes and/or SSc specific autoantibodies. Some lSSc patients who have no cutaneous involvement but common SSc nail fold capillaroscopy abnormalities, specific antinuclear antibodies, and visceral involvement are sometimes called SSc sine scleroderma. Eric Hachulla. Clinical Reviews in Allergy and Immunology. February 09, 2010. (Also see Diagnosis)
CREST Syndrome, by itself, does not have any skin tightening at all. CREST stands for Calcinosis, Raynaud's, Esophagus, Sclerodactyly, and Telangiectasia. CREST may occur alone, or in combination with any other form of Scleroderma (or even other autoimmune diseases) such as CREST with Limited Scleroderma, or CREST with Lupus. ISN.
|Overview: What is CREST?
CREST Patient Stories
Limited Scleroderma is when skin involvement is limited to the hands (although the face and neck may also be involved.) ISN.
|What is Limited Scleroderma?
Diagnosis of Limited Scleroderma
Research for Limited Scleroderma
|Online Support for Limited Scleroderma
Patient and Caregiver Stories
Diffuse Scleroderma is when skin tightening also occurs above the wrists (or elbows, see below). There are several subcategories of Diffuse, such as Scleroderma sans Scleroderma where there is internal organ fibrosis, but no skin tightening; and Familial Progressive Systemic Sclerosis, a rare form which runs in families. ISN.
Sine: Without Skin Fibrosis
|Overview of Polyautoimmunity
Scleroderma in Overlap
Connective Tissue Disease (CTD)
Mixed Connective Tissue Disease (MCTD)
|Multiple Autoimmune Syndrome
Undifferentiated Connective Tissue Disease (UCTD)
Overlap Patient and Caregiver Stories
Juvenile Scleroderma by ISN.
Reading Voices of Scleroderma Books: Diana Kramer.
Sharing Scleroderma Awareness Bracelets: Deb Martin, Brenda Miller, Vickie Risner.
Thanks to UNITED WAY donors of Central New Mexico and Snohomish County!
Patricia Ann Black: Marilyn Currier, Shelley Ensz, Richard Howitt, Gerald and Pat Ivanejko, Juno Beach Condo Association, Keith and Rosalyn Miller, and Elaine Wible.
Gayle Hedlin: Daniel and Joann Pepper and Nancy Smithberg.
Janet Paulmenn: Cindy Dorio, Shelley Ensz, Margaret Hollywood, and Michele Maxson.
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