{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:24:22Z","timestamp":1777983862840,"version":"3.51.4"},"reference-count":13,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The overlapping of systemic sclerosis with hematologic malignancy has been described previously in the literature. This case report presents a patient with systemic sclerosis and multiple myeloma who had severe digital ischaemia that culminated in the amputation of several fingers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report:<\/jats:title>\n                    <jats:p>A 65-year-old White female patient was diagnosed with limited systemic sclerosis in 2002, smouldering multiple myeloma IgG\/kappa in 2017 and liver cirrhosis in 2018 due to autoimmune hepatitis. In 2021, she was admitted to the emergency room with dry ischaemia of all fingers and toes despite optimized therapy, associated with visual blurring. The diagnostic hypothesis was hyperviscosity syndrome associated with multiple myeloma reactivation. The patient underwent chemotherapy and despite initial laboratory improvement, 19 digits required amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although the association between systemic sclerosis and multiple myeloma is rare, it should be remembered in cases of significant worsening of Raynaud\u2019s phenomenon. Causes unrelated to systemic sclerosis should also be considered in the presence of severe exacerbations in patients with other comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23971983231171248","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T04:51:12Z","timestamp":1682657472000},"page":"NP9-NP13","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Critical digital ischaemia in systemic sclerosis exacerbated by multiple myeloma: A case report"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6526-0140","authenticated-orcid":false,"given":"Andre Silva","family":"Franco","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel Berlingieri","family":"Polho","sequence":"additional","affiliation":[{"name":"Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-6918","authenticated-orcid":false,"given":"Ana Paula","family":"Luppino Assad","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata","family":"Miossi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9843-6686","authenticated-orcid":false,"given":"Percival Degrava","family":"Sampaio-Barros","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"bibr1-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30933-9"},{"key":"bibr2-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2020.03.002"},{"key":"bibr3-23971983231171248","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.03112"},{"key":"bibr4-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211448"},{"key":"bibr5-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmv.2016.07.001"},{"key":"bibr6-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.08.016"},{"key":"bibr7-23971983231171248","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-019-2072-1"},{"key":"bibr8-23971983231171248","volume":"2017","author":"Colaci M","year":"2017","journal-title":"Case Rep 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