Patient subgroups and potential risk factors in systemic sclerosis: is there a possibility of an early diagnosis?

Systemic sclerosis is often well established at diagnosis, when the disease has already evolved to an obliterative vasculopathy, with fibrosis and significant end-organ damage. The present classification criteria perform poorly when attempting to make an early diagnosis, limiting the possibility of an early treatment and of preventing disease evolution and tissue damage, leading to loss of function and impairment of quality of life (QOL). Recently the experts have then identified as Raynaud’s phenomenon, ANA and puffy fingers as “red flags” of which at least two must be present to further determine, as diagnostic tools for the diagnosis, specific antibodies (aca, topo I) and capillaroscopy. ‘‘Red flags’’ can help in the very early phase of the disease to track patients in the earliest phase of the disease and at risk of progressing to overt disease. This “window of opportunity” may allow the treatment of the disease at a still reversible phase when safe, efficacious and curative treatments will be available.