GENERALIZED scleroderma is recognized as a disseminated disease which may involve not only the skin but many other organs. It is usually a chronic illness with a gradual downhill progression and lasts from months to years.
GENERAL OBSERVATIONS
The course of scleroderma can be divided into two phases: the first is characterized by Raynaud-like phenomena; the second is initiated by the appearance of constitutional symptoms, including malaise, myalgia, and arthralgia and later is characterized by the development of visceral manifestations. These later phenomena result from the structural and functional derangements consequent to the degeneration of parenchymal cells and the simultaneous proliferation of connective tissue, in such diverse systems as skin, subcutaneous tissue, muscle, tendon and fascia, bones, blood vessels, serous surfaces, internal organs, endocrine glands, and the nervous system. These widespread and continuing alterations, resulting at least in part from the proliferation of fibrous tissue, have led Goetz 1 to