Preparing for your appointment
Preparing for an appointment may be helpful to know the questions you'd like to ask.
Dr John Pauling talks about why auto-antibodies are used for scleroderma diagnosis in the clip below:
If you experience symptoms of Raynaud's or Scleroderma it's important to get an appointment with your GP as soon as possible to get yourself booked into the NHS system as it can take time to get appointments and to get diagnosed.
After a thorough physical exam by your GP including Raynaud's tests as Raynaud's is one symptom of scleroderma, you may be referred to a consultant or specialist for further tests and tests for scleroderma.
The first step is to have an antinuclear antibodies (ANA) blood test. This test checks for an overactive immune system, which is common in people with autoimmune conditions such as scleroderma.
If a conclusive result cannot be given the doctor may remove a small tissue sample (biopsy) of your affected skin so that it can be examined in the laboratory for abnormalities.
Your doctor may also suggest breathing tests (pulmonary function tests), a CT scan of your lungs and an echocardiogram of your heart.
This test is performed by means of a state-of-the-art infra-red camera that sees the heat generated by the human body and translates it into colour scale which can map a patient's skin temperature. The measurements are made in a cool, temperature-controlled room, where the patient first rests for 15 minutes to acclimatise. Electronic images are then taken using a thermal imaging camera which detects the infra-red radiation which is continuously given off. The amount of radiation detected depends on the temperature of the surface viewed and the images are colour coded to show the temperature distribution. Lower temperatures appear as blue and higher ones as red, pink or white. Thermography is non-invasive which makes it particularly suitable for use with children and for repeated measurements.
In this test the capillaries at the base of the nail may be examined with an ophthalmoscope, magnifying lens or with a capillary microscope, to look for abnormal patterns. The result is positive if significant damage to the very small blood vessels is observed. There are however, a group of patients who have abnormal nailfold capillaries and/or positive antinuclear antibodies, but who after follow up do not develop definite connective tissue disease. These patients have autoimmune Raynaud's.
This technique is used mostly as a research tool at a number of specialist centres. Laser Doppler measures the blood flow in the small skin vessels by illuminating the skin with very low power laser light, and detecting the light scattered back from the skin. Some forms of laser Doppler involve attaching a probe to the skin surface, whereas others involve a light beam that scans across the skin surface to produce an image of blood flow over an area. Further refinements allow those measurements to be made whilst the skin is gently heated, or whilst a test drug is applied to a small area of skin.
You then may be given a diagnosis, or even a referral to another specialist in one area as scleroderma can affect different parts of the body.