In systemic sclerosis, which organ systems can be involved?

• A. GI involvement
• B. Pulmonary involvement
• C. Renal involvement
• D. All of the above

Answer: (D)

Systemic sclerosis can affect multiple organ systems because the underlying process—fibrosis and small-vessel vasculopathy—can involve many tissues. That’s why GI tract involvement, lung involvement, and kidney involvement can all occur, making “all of the above” the best answer.

In the GI tract, smooth muscle fibrosis leads to hypomotility of the distal esophagus with reduced LES tone, causing reflux and dysphagia. Motility problems can also affect other parts of the GI tract, producing bloating, malabsorption, and bacterial overgrowth.

Pulmonary involvement includes interstitial lung disease from fibrosis and pulmonary arterial hypertension from vascular remodeling. Both can cause progressive dyspnea and reduced exercise tolerance.

Renal involvement most notably presents as scleroderma renal crisis, with abrupt hypertension and acute kidney injury; it’s driven by vascular injury and can be rapidly progressive, often responsive to ACE inhibitors.

Because all these systems can be affected, the correct concept is that systemic sclerosis has potential involvement across GI, pulmonary, and renal systems.