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Am Fam Physician. 2026;113(4):349-357

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Systemic sclerosis is a rare autoimmune connective tissue disease characterized by progressive fibrosis of the skin and internal organs, vasculopathy, and the presence of specific autoantibodies. Despite its low prevalence, systemic sclerosis is associated with high morbidity. Early features often include Raynaud phenomenon, hand edema, and fatigue. Diagnosis requires a comprehensive approach, including clinical assessment, laboratory evaluation, imaging, and pulmonary function testing. The American College of Rheumatology and European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism) provide classification criteria and updated treatment recommendations. Management focuses on addressing eight disease domains: Raynaud phenomenon, digital ulcers, pulmonary artery hypertension, interstitial lung disease, renal crisis, gastrointestinal involvement, skin fibrosis, and musculoskeletal involvement. Vasodilator therapy is first-line treatment for Raynaud phenomenon, whereas phosphodiesterase-5 inhibitors and intravenous iloprost are used to treat digital ulcers. Combination therapy with phosphodiesterase-5 inhibitors and endothelin receptor antagonists is first-line treatment for pulmonary artery hypertension. Mycophenolate mofetil is the preferred treatment for interstitial lung disease.

Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune connective tissue disease characterized by immune dysregulation, widespread microvascular dysfunction, and progressive fibrosis of the skin and internal organs. The cause is unknown, but it is believed that abnormal immune system activity stimulates fibroblasts to overproduce collagen, leading to tissue fibrosis. The term SSc is preferred because scleroderma denotes primarily cutaneous features, while prognosis is largely driven by visceral involvement.

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