Is nucleolar pattern always diffuse scleroderma?

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.
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.