A 40-year-old woman presents with severe joint pains for 1 month. She also says her skin feels firm and tight for the past 6 months and progressed rapidly since then. Further history reveals features of mild Raynaud's syndrome for 6 months. On examination, the skin over the fingers, legs, arms, and trunk appear firm and indurated on palpation. Which of the following antibodies will most likely be elevated in this patient?
Anti-double-stranded DNA antibody
Anti–topoisomerase I antibody
Anti-Smith antibody
Anticentromere antibody
Explanation: Anti–topoisomerase I antibody
The given clinical scenario of severe arthralgia and diffuse involvement of the skin with rapid progression, along with a recent history of Raynaud's phenomenon, is suggestive of diffuse systemic sclerosis.
Anti–topoisomerase I antibody is most likely to be elevated in this patient.
Reasons why this cannot be limited to systemic sclerosis:
The onset of Raynaud's syndrome coincides with the onset of skin symptoms, whereas in limited systemic sclerosis, it precedes skin symptoms and has a history of over a decade.
Here Raynaud's is less severe, whereas in limited systemic sclerosis, it is more severe.
Here, the skin involvement is diffuse, including the trunk, and showed rapid progression, which are features of diffuse systemic sclerosis.
Systemic sclerosis is a chronic and progressive disease that involves sclerosis of the skin and the organs. It can be divided into limited cutaneous systemic sclerosis (lcSSc) and diffuse cutaneous systemic sclerosis (dcSSC) depending on the extent of skin involvement.
In lcSSc, the skin involvement has a slow progression and is limited to fingers, distal to elbows, and face. This disease has a slow progression. On the contrary, in dcSSc, the skin involvement is early and rapid. It can involve fingers, extremities, face, and trunk. They also have severe joint pains and musculoskeletal involvement.
Other options:
Options 1 and 3- Anti-double-stranded DNA antibody and anti-Smith antibody are seen in systemic lupus erythematosus. The patients might have a rash over the malar eminences or circular lesions with slightly raised, scaly hyperpigmented erythematous rims. They might also have swelling and tenderness in their hands, wrists, and knees.
Option 4- Anti-centromere antibody is seen in limited cutaneous systemic sclerosis. Here, the skin involvement is seen distal to the elbow, in the extremities, and distal to the elbows.
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