The symptoms of Raynaud phenomenon, arthralgia, and dysphagia point toward the diagnosis of scleroderma. Scleroderma, or systemic sclerosis, is characterized by a systemic vasculopathy of small-and medium-sized vessels, excessive collagen deposition in tissues, and an abnormal immune system It is an uncommon multisystem disease affecting women more often than men. There are two variants of scleroderma-a limited type (previously known as CREST syndrome) and a more severe, diffuse disease. Antinuclear antibodies are almost universal. Anti-Scl-70 (also known as anti-topoisomerase-1) antibody occurs in only 30% of patients with diffuse disease, but a positive test is highly specific. Anti-centromere antibodies are more often positive in limited disease. Rheumatoid factor is nonspecific and present in 20% of patients with scleroderma. Elevated CK and anti-Jo-1 antibodies are expected in an inflammatory myositis such as polymyositis. Skin thickening similar to scleroderma can be seen in nephrogenic systemic fibrosis (NSF), a progressive condition that occurs in patients with stage 5 chronic kidney disease, but NSF almost always follows gadolinium administration for an MR scan. Reproduction of Raynaud phenomena is nonspecific and is not recommended as an office test.