A 55-year-old woman presents to the rheumatology clinic with complaints of progressive difficulty swallowing, recurrent heartburn, and intermittent cold-induced color changes in her fingers. She has also noticed firm, tight skin on her fingers, making it difficult to fully extend them. Additionally, she reports the appearance of red spots on her face and hands over the past year. She denies any joint pain, fevers, or weight loss. History & Physical Examination Past Medical History: Long-standing Raynaud’s phenomenon affecting her fingers, first noticed in her 40s. Family History: No known autoimmune disorders. Social History: No smoking or alcohol use. Medications: Occasional use of ibuprofen for headaches. Physical Examination: Vitals: Normal temperature, BP: 130/85 mmHg, HR: 78 bpm. Hands: Tight, thickened skin over the fingers (sclerodactyly). Raynaud’s phenomenon: Color changes in fingers upon cold exposure (white → blue → red). Face & Extremities: Telangiectasias (small red spots) over the face and hands. No synovitis or joint swelling. GI Examination: No tenderness. No hepatosplenomegaly. Which of the following findings is most characteristic of this patient’s condition?
