System	Manifestation	History and physical examination findings
Cardiovascular	Abnormal cardiac conduction	—
	Congestive heart failure	Edema, extra heart sound (S3)
	Diastolic dysfunction (secondary to left ventricular fibrosis)
	Pericardial effusion
	Digital ischemic changes	Abnormal capillaries on the nail fold
		Acro-osteolysis
		Digital pitting or ulceration
		Pterygium inversus unguis (i.e., distal nail bed adherence to the ventral surface of the nail plate)
	Raynaud phenomenon	Color changes in the fingers precipitated by exposure to cold Temperature or emotional stress: white (vasospasm), blue-purple (ischemia), and red (hyperemia)
Gastrointestinal	Bacterial overgrowth	Anemia
	Barrett esophagus or strictures	—
	Gastric antral vascular ectasia (watermelon stomach)	Anemia
		Gastrointestinal bleeding
	Gastroesophageal reflux disease	Chronic cough
		Dental erosions
		Dysphagia
		Halitosis
		Pharyngitis
	Intestinal malabsorption	Wasting, diarrhea
	Pseudo-obstruction	Obstructive symptoms
Genitourinary	Sexual dysfunction	Dyspareunia, impotence
Musculoskeletal	Flexion contractures	Prayer or steeple sign (inability to directly bring hands together because fingers will not fully extend)
	Muscle atrophy (secondary to myositis [overlap syndrome] or deconditioning)	Weakness
	Puffy hands	Diffusely swollen hands without synovitis
		Inability to make a tight fist
	Tendon friction rubs	Palpable or audible rubs with active flexion or extension of fingers, wrists, knees, or ankles
Pulmonary	Interstitial lung disease	Basilar, course crackles
		Cough
		Dyspnea on exertion
	Pulmonary arterial hypertension	Dyspnea on exertion
		Extra heart sound (right-sided S3)
		Fixed splitting of S2
		Right ventricular heave
		Syncope
Renal	Renal crisis	Abnormal funduscopy examination findings
		Hypertension
		Schistocytes on peripheral smear
Skin	Calcinosis	Calcium deposits along extensor tendons and on digits
	Hyper- or hypopigmentation	Tanned skin on sun-exposed and unexposed areas or loss of pigmentation
	Pruritus	Excoriations, scabbing
	Telangiectasias	Matte-like vascular abnormalities that blanche on palpation
	Thickened skin	Reduced oral aperture
		Sclerodactyly
		Tight skin