**4.2 Gastrointestinal system involvement**

Ninety percent of scleroderma patients show gastrointestinal involvement. Although it can involve any part of the gastrointestinal tract from the mouth to the anus, the esophagus is the most commonly involved area [27]. The most common complications of SSc in the oral cavity are microstomy and xerostomy. Symptoms of esophageal disease depend on dysmotility and reflux, and related to this, dysphagia, odynophagia, regurgitation, pyrosis, chronic cough, or hoarseness can occur. Stricture, Barrett's esophagus, aspiration pneumonia, and adenocarcinoma may develop as complications in these patients [27, 28]. The two most common symptoms of SSc in the stomach are gastroparesis and gastric antral vascular ectasia (GAVE). A typical striped watermelon appearance is present. Iron deficiency anemia due to GAVE may also be seen [28]. After bacterial growth due to small intestinal involvement, diarrhea and malabsorption or pseudo-obstruction due to hypomotility and dilatation may be observed [28]. Constipation, fecal, rectal prolapse, spontaneous perforation, and colon infarction may develop in the colon and have anorectal involvement [29].

**125**

dysfunction [35].

*Systemic Sclerosis*

artery [31].

drome [31].

**4.5 Cardiac involvement**

trophy, and heart failure may develop [34].

*DOI: http://dx.doi.org/10.5772/intechopen.91318*

imaging and can show the degree of fibrosis.

**4.4 Musculoskeletal involvement**

deposits in the tendon sheath [32].

Pulmonary involvement, the most important cause of mortality and morbidity in SSc, may occur in the form of interstitial lung disease (ILD) or pulmonary arte-

The highest risk for ILD development is within the first 5 years of the disease. Progressive exercise dyspnea and nonproductive cough are the most common symptoms. Diagnosis is placed with the help of imaging methods and pulmonary function tests. High-resolution computed tomography is a sensitive method in

Pulmonary artery hypertension affects approximately 15% of scleroderma patients and leads to right heart failure, and the gold standard method for the diagnosis of PAH is right heart catheterization with high pressure in the pulmonary

The most common involvement of the musculoskeletal system in SSc are tendinopathy, joint contractures, and in some cases arthritis. In 45–90% of patients, arthralgia and arthritis of the small joints of the wrist, knees, and ankles occur [31]. Tenosynovitis and tendon ruptures are frequently detected in SSc. Tendon friction sound that can be detected by physical examination is caused by fibrotic

be seen in SSc patients. These changes are related to digital ischemia [31].

involvement or sometimes as a side effect of treatment.

Calcinosis and acroosteolysis in the bones (resorption of terminal phalanx) can

Although respiratory muscle involvement is not common in SSc, respiratory

Cardiac involvement in SSc can be seen in two ways: primary and secondary. Secondary involvement may be secondary to pulmonary arterial hypertension, interstitial lung disease, or kidney disease [33]. Primarily, all layers of the heart, conduction system, coronary vessels, and valves can be involved. Because of these involvements, pericardial effusion, supraventricular or ventricular arrhythmias, conduction disorders, valve regurgitation, myocardial ischemia, myocardial hyper-

Because myocardial findings are often faint, especially in the early stage, it is very difficult to detect these patients. However, when the involvement progresses to the symptomatic stage, the patient develops one of the poor prognostic factors [31]. Therefore, early diagnosis of cardiac involvement in SSc is very important. Electrocardiography or echocardiography is not effective in detecting cardiac fibrosis. Magnetic resonance imaging (MRI) is the only method that can detect cardiac involvement in the early stages of the disease. A cardiac MRI can show myocardial inflammation, fibrosis, decreased perfusion of the heart muscle, and ventricular

muscles may be affected in SSc-polymyositis/dermatomyositis overlap syn-

In addition, muscle weakness and pain, which mainly affects the proximal muscles, is another common symptom in SSc. Muscle involvement may occur in the form of myopathy or myositis, and patients should be evaluated from this angle [31]. Muscle weakness may result from nonuse, sedentary life, or joint/tendon

**4.3 Pulmonary involvement**

rial hypertension (PAH) [30].
