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A 48-year-old woman has noted that during the past month her fingers become cold and painful on exposure to cold. She has mild dyspnea, but no wheezing. She is found to have a blood pressure of 170/110 mmHg. Her 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. Which of the following autoimmune diseases is she most likely to have?
A. discoid lupus erythematosus
B. polymyositis-dermatomyositis
C. progressive systemic sclerosis
D. sjogren syndrome
E. rheumatoid arthritis
So I did end up choosing the right answer based on the fact that the pt. had CREST, but that was the only clue I could find from the question stem. What else could have led specifically to scleroderma? The solution says the "nucleolar pattern" suggests scleroderma (systemc sclerosis), but I am not sure if I understand this. Can anyone explain this pattern and the association with scleroderma? Many thanks in advance.
A. discoid lupus erythematosus
B. polymyositis-dermatomyositis
C. progressive systemic sclerosis
D. sjogren syndrome
E. rheumatoid arthritis
So I did end up choosing the right answer based on the fact that the pt. had CREST, but that was the only clue I could find from the question stem. What else could have led specifically to scleroderma? The solution says the "nucleolar pattern" suggests scleroderma (systemc sclerosis), but I am not sure if I understand this. Can anyone explain this pattern and the association with scleroderma? Many thanks in advance.