Is nucleolar pattern always diffuse scleroderma?

Nucleolar Pattern: There are many different kinds of the nucleolar pattern. It can be speckled, cytoplasmic etc. Knowing what the pattern was is important in trying to figure out what is going on. That being said, if all you know is that it was nucleolar it can mean that you have some sort of "overlap" syndrome, which can include lupus, sjogrens syndrome, crest, scleroderma etc.

Probably not!: While many with systemic scleroderma do have a "nucleolar" ana, most patients that i see have no manifestations of disease. So, do we know in twenty years what will happen. No. These studies have not been done. A positive ANA without disease manifestations is a "false" positive. Apart from the ANA pattern, 5% of the population has a positive ANA and no connective tissue disease.

Not necessarily: False positive anas and false ANA pattern identification can occur.

No. Nucleolar pattern staining of the ANA must be correlated with the clinical features. A positive test may confirm scleroderma (diffuse type or limited type) or an overlap between scleroderma and polymyositis. The antibody is sometimes found in patients with Raynaud's phenomenon or in normal individuals. The question is why the test was done. It is NOT a screening test for non-specific symptoms.