What is the criteria for diagnosing scleroderma and what are the recommendations for managing scleroderma renal crisis?

From Current Rheumatology (McGraw-Hill, 2007)

Most frequent symptoms in (descending order):
Raynaud phenomenon
gastroesophageal reflux with or without dysmotility
skin changes
swollen fingers
arthralgias

Other factors:
* A negative antinuclear antibody test makes the diagnosis of scleroderma very unlikely.
* The degree of skin involvement is highly variable. Many patients with limited scleroderma have only subtle cutaneous findings (eg, mild sclerodactyly).
* The available diagnostic criteria do not include many patients with milder forms of scleroderma.
* Some patients may have overlapping clinical features with other systemic autoimmune rheumatic disorders such as polymyositis/dermatomyositis, Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis.

From Uptodate (On campus access only):

See article entitled "Diagnosis and differential diagnosis of systemic sclerosis (scleroderma) in adults"

For management of renal crisis, see article on "Scleroderma renal crisis"

Is aspirin effective for prevention of CVAs?

Cochrane Library

Aguilar M, Hart R. Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001925. PMID: 16235290

Under Graphics, go to Comparison 01 (Antiplatelet versus control...)

Is BNP useful in diagnosing heart failure?

Cochrane Library and EBM Reviews
No completed systematic reviews or meta-analyses

PubMed

1. Maisel AS, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002 Jul 18;347(3):161-7.

Objective: "to validate and characterize the use of B-type natriuretic peptide levels in the diagnosis of congestive heart failure in a broad population of patients with dyspnea"

Gold standard: ED physician assessment (blinded to the BNP results); 2 independent cardiologists (also blinded) confirmed clinical dx based on
* Framingham congestive-heart-failure score
* National Health and Nutrition Examination Survey (NHANES) congestive heart failure score
* Other information from the ED (chest x-ray, echo, pt history, etc.)

Population: 1,586 pts (of 1,666 presenting) at 7 sites; seen in ED for dyspnea
Characteristics

Results include ROC curve for various cutoffs of BNP


2. Anwaruddin S, et al. Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. J Am Coll Cardiol. 2006 Jan 3;47(1):91-7.

Objective: "to examine the interaction between renal function and amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels"

Gold standard: Dx by cardiologist blinded to BNP & NT-proBNP; based on ED & hospital records, diagnostic imaging, lab tests, etc.

Population: 599 pts who presented at the ED of an urban hospital and who met criteria for inclusion

Results: Include ROC curve comparing NT-proBNP concentrations in patients with different GFR measures

Tools