26th February 2025

A 25-year-old female is referred to rheumatology clinic by her general practitioner.

A 25-year-old female is referred to rheumatology clinic by her general practitioner. Over the last few years, she has noted her fingers get very cold and go white when she goes outside, and when she re-enters a warm environment, they become red and become painful. She is having increasing trouble making a fist with her hands and feels her skin looks thick and shiny. She also feels that she can’t open her mouth as wide as she used to be able to. She has been using Gaviscon regularly as she has noted that she has been experiencing increased heartburn, and occasionally finds it difficult to swallow her food.

She has no past medical history and takes no regular medications except for Gaviscon as required.

On examination you notice swollen, puffy hands with shiny, thick skin. She struggles to make a fist due to hand swelling. She has some red lesions to her fingers and mouth. She has no joint swelling or tenderness.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.