The face and trunk may also occasionally be involved, with changes resembling systemic sclerosis. Carpal tunnel syndrome may also occur. Raynaud's phenomenon is not a feature. Symptoms usually appear insidiously, with gradual restriction of arm and leg movement. Fascial involvement is characteristic, but the process may also involve tendons, synovial membranes, and muscle.
Contractures commonly evolve, secondary to induration and thickening of the fascia.
Fatigue and weight loss are common. Although muscle strength is unimpaired, myalgia and arthritis may occur. Diagnosis Laboratory studies in early active disease show eosinophilia, elevated ESR, and a polyclonal IgG hypergammaglobulinemia. Serious hematologic disease, especially a lymphoproliferative process, may rarely develop. Antinuclear antibodies and rheumatoid factor are absent.