Thickening and decreased flexibility of the skin of the fingers and other body parts is characteristic of scleroderma. Raynaud’s phenomenon is almost always present, although it should be noted that about 4% of the general population also has Raynaud and most of these people will never develop scleroderma. Painful ulcers can occur at the fingertips. The fingers can gradually become fixed in a bent or flexed position. Arthritis (joint pain and swelling) and muscle weakness may also occur. Esophagus involvement can cause heartburn, regurgitation and difficulty swallowing. Small intestine involvement may cause an intestinal obstruction and reduce the ability to absorb food. The lung or heart involvement can cause shortness of breath. The involvement of the kidneys can manifest itself as a severe arterial hypertension crisis and reduced kidney function (renal failure). Some patients have a significant weight loss, while others have a persistent pruritus (itchy skin). Fatigue and decreased ability to carry out daily activities are pervasive. Scleroderma is a major cause of physical and moral suffering and decreased quality of life.