{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T14:25:10Z","timestamp":1764253510381,"version":"3.46.0"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Key Clinical Message<\/jats:title>\n                    <jats:p>Even in the absence of characteristic cutaneous symptoms of scleroderma, systemic sclerosis should be considered in the differential diagnosis of patients initially diagnosed with idiopathic interstitial lung disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Systemic sclerosis (SSc) is an idiopathic connective tissue disorder characterized by multisystem involvement. Although skin thickening is a hallmark manifestation of SSc, a subset known as systemic sclerosis sine scleroderma (ssSSc) presents with internal organ involvement and positive serologic markers in the absence of significant cutaneous manifestations. We report the case of a 36\u2010year\u2010old Iranian woman who presented with clubbing as an initial symptom of ssSSc. Notably, clubbing as the sole initial sign of the disease has not been previously reported. Timely diagnosis of ssSSc is crucial to facilitate appropriate treatment and prevent disease progression. Physicians should adopt a comprehensive approach when evaluating patients presenting with limited clinical features, as they might be indicative of underlying ssSSc.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccr3.8090","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T02:42:05Z","timestamp":1697769725000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A case report of clubbing as the initial sign of systemic sclerosis sine scleroderma: A rare possible presentation"],"prefix":"10.1002","volume":"11","author":[{"given":"Anahita","family":"Amirpour","sequence":"first","affiliation":[{"name":"Department of Rheumatology Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5077-7307","authenticated-orcid":false,"given":"Parastoo","family":"Ghorbani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3903-0464","authenticated-orcid":false,"given":"Erfan","family":"Ghadirzadeh","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elham","family":"Charkazi","sequence":"additional","affiliation":[{"name":"Semnan University of Medical Sciences  Semnan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elham","family":"Paraandavaji","sequence":"additional","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keab738"},{"issue":"4","key":"e_1_2_11_3_1","first-page":"68","article-title":"Sine Scleroderma","volume":"68","author":"Kaur G","year":"2020","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.17219\/acem\/64334"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1962.03050210027006"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-022-03462-z"},{"issue":"1","key":"e_1_2_11_7_1","first-page":"1","article-title":"Sine scleroderma, limited cutaneous, and diffused cutaneous systemic sclerosis survival and predictors of mortality","volume":"23","author":"De Almeida CS","year":"2021","journal-title":"Arthritis Res Ther"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1740506"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.reuma.2016.11.004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2022.01.023"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000163"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket163"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-009-0878-7"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.8090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T14:22:14Z","timestamp":1764253334000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.8090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/ccr3.8090"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.8090","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"type":"print","value":"2050-0904"},{"type":"electronic","value":"2050-0904"}],"subject":[],"published":{"date-parts":[[2023,10]]},"assertion":[{"value":"2023-07-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e8090"}}