{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T13:29:31Z","timestamp":1768310971417,"version":"3.49.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"748","license":[{"start":{"date-parts":[[1988,2,1]],"date-time":"1988-02-01T00:00:00Z","timestamp":570672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1988,2,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Difficulty in the diagnosis of the disease scleroderma may occur at the early stage prior to the development of obvious skin sclerosis. A presumptive diagnosis may be made if Raynaud\u2019s phenomenon is accompanied by a positive \u2018neck test\u2019, \u2018scleroderma\u2019 capillary changes in the nailfolds or antinuclear antibodies. Definitive diagnosis may have to be delayed for several years from the onset of Raynaud\u2019s phenomenon until definite characteristic skin changes are seen. Ten cases in which an earlier diagnosis of scleroderma was not substantiated are listed. The earlier incorrect diagnosis would have been avoided by use of the methods described in this paper.<\/jats:p>\n               <jats:p>Various terms have been used to denote subdivisions of scleroderma. These include acrosclerosis, diffuse scleroderma and CREST. We have used the terms Type 1, Type 2 and Type 3 based on the early extent of the skin sclerosis where Type 1 (limited extent) indicates sclerodactyly only, Type 2 (moderate extent) indicates sclerosis proximal to the metacarpophalangeal joints but excluding the trunk and Type 3 (extensive) indicates diffuse skin sclerosis including the trunk. The clinical value of this simple classification is reviewed and contrasted to other classifications which appear to be poorly defined and of limited use.<\/jats:p>","DOI":"10.1136\/pgmj.64.748.121","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T21:05:27Z","timestamp":1230584727000},"page":"121-125","source":"Crossref","is-referenced-by-count":26,"title":["The diagnosis and classification of scleroderma (systemic sclerosis)"],"prefix":"10.1093","volume":"64","author":[{"given":"Alfred J","family":"Barnett","sequence":"first","affiliation":[{"name":"Alfred Hospital , Melbourne , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian","family":"Miller","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Prince Henry\u2019s Hospital , Melbourne , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey O","family":"Littlejohn","sequence":"additional","affiliation":[{"name":"Monash University Department of Medicine , Melbourne , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1988,2,1]]},"reference":[{"key":"ref_1","first-page":"337","article-title":"The pathology of progressive systemic sclerosis (generalized scleroderma) with special reference of changes","volume-title":"viscera. Clin Proc 1945, 4","author":"Goetz, R.H.","unstructured":"Goetz, R.H. The pathology of progressive systemic sclerosis (generalized scleroderma) with special reference of changes in viscera. Clin Proc 1945, 4: 337-392."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/art.1780230510","article-title":"Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Subcommittee. Preliminary criteria for the classification of systemic sclerosis (scleroderma)","volume":"23","year":"1980","unstructured":"Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Subcommittee. Preliminary criteria for the classification of systemic sclerosis (scleroderma). 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Association of autoantibodies to ribonucleoprotein and Sm antigens with mixed connective tissue disease, systemic lupus erythematosus and other rheumatic diseases. N Engl J Med 1976, 296: 1149-1154.","journal-title":"N Engl J Med"},{"issue":"180","key":"ref_12","first-page":"665","article-title":"Progressive systemic sclerosis sine scleroderma","volume":"1962","author":"Rodnan, G.P.; Fennell, R.H.","unstructured":"Rodnan, G.P. & Fennell, R.H. Progressive systemic sclerosis sine scleroderma. JAMA 1962, 180: 665-670.","journal-title":"JAMA"},{"issue":"163","key":"ref_13","first-page":"343","article-title":"Die Akrosclerosis (Sklerodatylie) und deren Symptomenkomplex nebst neueren Untersuchungen bei Sklerodermie","volume":"1981","author":"Sellei, J.","unstructured":"Sellei, J. Die Akrosclerosis (Sklerodatylie) und deren Symptomenkomplex nebst neueren Untersuchungen bei Sklerodermie. 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The anticentromere body: disease specificity and clinical significance, Mayo Clin Proc 1984, 69: 700-706."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/rheumatology\/26.1.17","article-title":"The clinical significance of the anticentromere antibody","volume":"26","author":"Miller, M.H.; Davidson, A.; Jones, B.; Littlejohn, G.; Topliss, D.","year":"1987","unstructured":"Miller, M.H., Davidson, A., Jones, B., Littlejohn, G. & Topliss, D. The clinical significance of the anticentromere antibody. Br J Rheum 1987, 26: 17-21.","journal-title":"Br J Rheum"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/64\/748\/121\/50078422\/postgradmedj-64-121.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/64\/748\/121\/50078422\/postgradmedj-64-121.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T14:10:57Z","timestamp":1683209457000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/64\/748\/121\/7047682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1988,2,1]]},"references-count":27,"journal-issue":{"issue":"748","published-online":{"date-parts":[[1988,2,1]]},"published-print":{"date-parts":[[1988,2,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.64.748.121","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1988,2]]},"published":{"date-parts":[[1988,2,1]]}}}