U.C.L.A. Rheumatology Pathophysiology of Disease Course Lecture, Second Year Medical School 2005

      When I evaluate patients, I'm also constantly attempting to differentiate between autoimmune mediated and non-autoimmune mediated disease. The pattern of organ involvement often aids in this determination.
       An example is this man who presented with joint pain, and partial amputations of his fingertips. The patient had no other complaints or physical findings, and when he was seen back in my clinic after six weeks, his condition had not changed.
       On the other hand, I was seeing this lady on a weekly basis, and every week there were changes. The erosions over the joints would change in size, and different joints became involved. The skin of here forearm initially became very red and the erythema traveled up her arm while it thickened and ulcerated. Her lungs developed Velcro rales, and she had the onset of trouble swallowing, or dysphagia. This pattern of organ involvement made a diagnosis of scleraderma, or progressive systemic sclerosis, easy to come by. The skin changes are called scleraderma, and the hand changes scleradactyle, Lung fibrosis, and involvement of the esophageal musculature is common in this disease, and lead to her complaints and the physical findings.