&Progressive Systemic Sclerosis (Scleroderma)=The earliest manifestations of diffuse Scleroderma (SSc) often are edema and swelling of the hands, arthralgia and myalgias. True inflammatory arthritis is uncommon in SSc. Joint pain, immobility and contractures develop as the result of fibrosis around tendons and other periarticular structures. Contractures of the fingers from this process are most common, but large joint contractures involving the wrists, elbows and ankles may also occur. The process is sometimes associated with palpable and/or audible deep tendon friction rubs. Tendon friction rubs occur predominantly in patients with diffuse SSc. The most common sites of involvement are the extensor and flexor tendons of the fingers and wrist, tendons over the elbow (triceps), knees (patellar), and ankle (anterior and posterior tibial, peroneal and Achilles). The common presentation of Scleroderma is joint pain, immobility, contractures of the fingers as a result of fibrosis around tendons and other periarticular structures. Large joints like the wrists, elbow and ankles can also be involved.