po
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A 54-year-old woman goes to her physician because she has noted that during the past month her fingers become cold and painful upon exposure to cold. She has mild dyspnea, but no wheezing. She is found to have a blood pressure of 170/110 mm Hg. The antinuclear antibody test is positive with a titer of 1:256 and a nucleolar pattern. Her serum urea nitrogen is 15 mg/dL with creatinine of 1.1 mg/dL. These findings most strongly suggest that she has which of the following autoimmune diseases?
A Discoid lupus erythematosus (DLE)
B Progressive systemic sclerosis (PSS)
C Polymyositis-dermatomyositis
D Sjogren's syndrome (SS)
E Rheumatoid arthritis (RA)
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| doc179
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B
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| new_n_lost
Politically InCorrect
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B Progressive systemic sclerosis (PSS)
Yup
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| po
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 (B) CORRECT. The nucleolar pattern suggests scleroderma (PSS) more than the other diseases. Complications of scleroderma include hypertension, though signs of renal failure may not occur unless the complication of malignant hypertension supervenes. She also has Raynaud's phenomenon and pulmonary fibrosis.
(A) Incorrect. DLE is characterized mainly by skin findings.
(C) Incorrect. The major autoantibody associated with PM is Jo-1. Renal disease is not a feature of this complex.
(D) Incorrect. SS primarily affects salivary and lacrimal glands.
(E) Incorrect. RA mainly affects small joints and is associated with an increased rheumatoid factor (RF). Renal disease is not a major feature of RA.
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