Which examination is recommended for a patient suspected of systemic sclerosis?

• A. Abdominal CT
• B. capillaroscopy
• C. Cardiac echo
• D. gastroscopy

Answer: (B)

Nailfold capillaroscopy is the most informative early test when systemic sclerosis is suspected because microvascular injury is a defining feature of the disease. Examining the capillaries at the fingernail beds with capillaroscopy often reveals a characteristic scleroderma pattern—giant capillaries, microhemorrhages, and loss of capillaries—that can support the diagnosis even before skin changes become obvious. This test is noninvasive, quick, and can also provide prognostic clues based on the extent of capillary abnormality.

Abdominal CT, cardiac echo, and gastroscopy don’t specifically diagnose systemic sclerosis. Abdominal CT looks for abdominal pathology, a cardiac echo assesses heart structure and function (useful in known disease for complications but not for initial diagnosis), and gastroscopy evaluates the upper GI tract (esophageal involvement is common in scleroderma, but endoscopy isn’t used to establish the rheumatologic diagnosis).