Skeletal muscle abnormalities occur in some patients with scleroderma and manifestations can vary from mild to severe. The incidence or prevalence of muscle involvement has been documented in several published series of patients.<sup>10 Clements P.J., Furst D.E., Campion D.S. , e al. Muscle disease in progressive systemic sclerosis Arthritis Rheum 1978 ;  21 : 62-71  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 25 Medsger T.A., Rodnan G.P., Moossy J. , e al. Skeletal muscle involvement in progressive systemic sclerosis (scleroderma) Arthritis Rheum 1968 ;  11 : 554-568  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 41 Thompson J.M., Bluestone R., Bywaters E.G.L. , e al. Skeletal muscle involvement in systemic sclerosis Ann Rheum Dis 1969 ;  28 : 281-288  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In the evaluation of the incidence of muscle abnormalities in scleroderma, careful consideration must be given to clinical overlaps with other connective tissue diseases, especially inflammatory myositis,<sup>24 Medsger T.A. Progressive systemic sclerosis: Skeletal muscle involvement Clin Rheum Dis 1979 ;  5 : 103-113

Cliccare qui per andare alla sezione Riferimenti</sup> and also myoadenylate deaminase deficiency<sup>18 Gertler P.A., Jacobs R.P. Myoadenylate deaminase deficiency in a patient with progressive systemic sclerosis Arthritis Rheum 1984 ;  27 : 586-590  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and inclusion body myositis,<sup>5 Averbuch-Heller L., Steiner I., Abramsky O. Neurologic manifestations of progressive systemic sclerosis Arch Neurol 1992 ;  49 : 1292-1295

Cliccare qui per andare alla sezione Riferimenti</sup> all of which have been described to coexist with scleroderma. The clinical manifestations and laboratory findings for the muscle abnormalities in scleroderma patients have been well characterized by a number of investigators. Many scleroderma patients, however, do not undergo complete evaluations for muscle dysfunction because the symptomatic weakness may be mild or because of concerns over severe skin involvement, which can complicate procedures such as electromyography or muscle biopsy. New noninvasive procedures such as MR imaging, P-31 magnetic resonance spectroscopy, and near infrared spectroscopy provide unique quantitative data that may be useful not only in the characterization of the disease but also in therapeutic decisions and long-term management of these patients.

Although muscle involvement in scleroderma is usually described as mild,<sup>40 Seibold J.R. Scleroderma Textbook of Rheumatology. Philadelphia: WB Saunders (1993).  1113-1143

Cliccare qui per andare alla sezione Riferimenti</sup> some patients develop a debilitating or even life-threatening course. Therefore, muscle abnormalities and their substantial consequences for scleroderma patients warrant serious consideration.