A 65-year-old woman presents with tightening of the skin on her hands and difficulty opening her mouth. She also has Raynaud’s phenomenon and dyspnea. On examination, her fingers are puffy, and her fingernails show telangiectasia. What is the most likely diagnosis? A) Rheumatoid arthritis B) Psoriatic arthritis C) Systemic sclerosis D) Dermatomyositis E) Polymyositis Correct Answer: C) Systemic sclerosis Explanation: Systemic sclerosis (scleroderma) presents with skin tightening (especially on the hands), Raynaud's phenomenon, and dyspnea due to pulmonary involvement. Telangiectasia and fingernail changes are common. Rheumatoid arthritis (A) presents with symmetric joint involvement and morning stiffness, but does not typically cause skin tightening or Raynaud’s in the absence of joint involvement. Psoriatic arthritis (B) can cause joint pain and skin lesions, but it is not typically associated with Raynaud’s phenomenon or tightening of the skin. Dermatomyositis (D) presents with muscle weakness, heliotrope rash, and Gottron’s papules, not skin tightening. Polymyositis (E) is associated with muscle weakness, but not skin tightening or Raynaud’s phenomenon. Key Tips for PLAB 1: ✅ Skin tightening, Raynaud’s phenomenon, and dyspnea = Systemic sclerosis ✅ Management = Symptomatic treatment for Raynaud’s and pulmonary involvement, with immunosuppressants for disease control
