A 42-year-old woman comes to the physician with 6 months of progressively worsening exertional dyspnea. She is unable to climb two flights of stairs without becoming short of breath. She also complains of dry cough, weight loss, and fatigue. She describes finger tingling and numbness when exposed to colder temperatures. Her past medical history is significant for acid reflux disease and diabetes mellitus. Her medications include metformin and omeprazole. She does not smoke cigarettes.
Her blood pressure is 155/80 mm Hg and her pulse is 86/min. Oxygen saturation is 94% on room air. Small ulcers are seen at the fingertips bilaterally. Jugular venous pressure is estimated at 6 mm H₂O. There are no heart murmurs. Inspiratory fine crackles are heard on auscultation at lung bases. There is no organomegaly.
Laboratory results are as follows:

Chest x-ray shows bilateral reticular opacities.
Which of the following antibodies is most likely to be positive in this patient?

Question

A 42-year-old woman comes to the physician with 6 months of progressively worsening exertional dyspnea. She is unable to climb two flights of stairs without becoming short of breath. She also complains of dry cough, weight loss, and fatigue. She describes finger tingling and numbness when exposed to colder temperatures. Her past medical history is significant for acid reflux disease and diabetes mellitus. Her medications include metformin and omeprazole. She does not smoke cigarettes.
Her blood pressure is 155/80 mm Hg and her pulse is 86/min. Oxygen saturation is 94% on room air. Small ulcers are seen at the fingertips bilaterally. Jugular venous pressure is estimated at 6 mm H₂O. There are no heart murmurs. Inspiratory fine crackles are heard on auscultation at lung bases. There is no organomegaly.
Laboratory results are as follows:

Chest x-ray shows bilateral reticular opacities.
Which of the following antibodies is most likely to be positive in this patient?

Quizplus · Accepted Answer

11ec193a_9927_2625_853d_37147e7640b2_MD0002_00 This patient's presentation is consistent with likely systemic sclerosis (SSc), as summarized in the table. She has features of Raynaud's phenomenon, fingertip ulcers, abnormal chest x-ray, and acid reflux disease. Raynaud's phenomenon Laboratory testing can usually confirm the diagnosis in clinically suspected patients. The most commonly seen antibodies include antitopoisomerase (SCL-70), anticentromere (ACA), and anti-RNA polymerase III. These antibodies also correlate with specific organ involvement (eg, lung, skin) and can sometimes correlate with prognosis. (Choice A) Anticitrullinated peptide antibodies (anti-CCP) are less common in SSc but more common in rheumatoid arthritis and overlap syndrome. (Choice C) Antimitochondrial antibodies (AMA) are usually seen in primary biliary cirrhosis (PBC). (Choice D) Antineutrophil cytoplasmic antibodies are not associated with SSc but are more commonly associated with vasculitis. (Choice E) Antisynthetase antibodies include anti-Jo-1 and are more specific for myositis. They are more commonly found in patients with dermatomyositis/polymyositis associated with interstitial lung disease. This patient has no muscle weakness. Educational objective: The combination of Raynaud's phenomenon, acid reflux disease, and skin findings is highly suggestive of systemic sclerosis. Laboratory tests that can help confirm the diagnosis include antitopoisomerase (SCL-70), anticentromere (ACA), and anti-RNA polymerase III. __________

A 42-Year-Old Woman Comes to the Physician with 6 Months