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Class I: No limitation of
physical activity. Ordinary
physical activity does not
cause undue fatigue,
dyspnea, or anginal pain.
Class II: Slight limitation of
physical activity. Ordinary
physical activity results in
symptoms.
Class III: Marked limitation
of physical activity.
Comfortable at rest, but
less than ordinary activity
causes symptoms.
Class IV: Unable to
engage in any physical
activity without discomfort.
Symptoms may be present
even at rest.
Secondary Pulmonary
Hypertension
Secondary pulmonary
hypertension with
established right
ventricular hypertrophy
leading to the presence of
permanent physical
impairment of at least
Class IV of the New York
Heart Association (NYHA)
Classification of Cardiac
Impairment.
The NYHA Classification
of Cardiac Impairment:
Class I: No limitation of
physical activity. Ordinary
physical activity does not
cause undue fatigue,
dyspnea, or anginal pain.
Class II: Slight limitation of
physical activity. Ordinary
physical activity results in
symptoms.
Class III: Marked limitation
of physical activity.
Comfortable at rest, but
less than ordinary activity
causes symptoms.
Class IV: Unable to
engage in any physical
activity without discomfort.
Symptoms may be present
even at rest.
31.
Progressive
Scleroderma
Early Progressive
Scleroderma
A rheumatologist must
make the definite
diagnosis of progressive
systemic scleroderma,
based on clinically
accepted criteria. This
diagnosis must be
unequivocally supported
by biopsy and serological
evidence.
The following are
excluded:
• localised scleroderma
(linear scleroderma or
morphea);
• eosinophilic fasciitis;
and
• CREST syndrome
Progressive
Scleroderma with
CREST syndrome
A rheumatologist must
make the definite
diagnosis of systemic
sclerosis with CREST
syndrome, based on
clinically accepted criteria.
This diagnosis must be
unequivocally supported
by biopsy and serological
evidence. The disease
must involve the skin with
deposits of calcium
(calcinosis), skin
thickening of the fingers or
toes (sclerodactyly) and
also involve the
esophagus. There must