Editing Systemic scleroderma (section)

==Causes==
No clear cause for scleroderma and systemic sclerosis has been identified. Genetic predisposition appears to be limited, as genetic concordance is small; still, a familial predisposition for autoimmune disease is often seen. Polymorphisms in ''[[COL1A2]]'' and ''[[TGF beta 1|TGF-β1]]'' may influence severity and development of the disease. Evidence implicating [[cytomegalovirus]] (CMV) as the original epitope of the immune reaction is limited, as is parvovirus B19.<ref>{{cite journal |pmid=10609071 | volume=17 | issue=6 | title=Parvovirus B19 infection of bone marrow in systemic sclerosis patients | year=1999 | journal=Clin. Exp. Rheumatol. | pages=718–20 |vauthors=Ferri C, Zakrzewska K, Longombardo G, Giuggioli D, Storino FA, Pasero G, Azzi A }}</ref> [[Organic solvent]]s and other chemical agents have been linked with scleroderma.<ref name=JimenezDerk/>

One of the suspected mechanisms behind the autoimmune phenomenon is the existence of [[microchimerism]], i.e. fetal cells circulating in maternal blood, triggering an immune reaction to what is perceived as foreign material.<ref name=JimenezDerk/><ref name=Bianchi>{{cite journal |author=Bianchi DW |title=Fetomaternal cell trafficking: a new cause of disease? |journal=Am. J. Med. Genet. |volume=91 |issue=1 |pages=22–8 |year=2000 |pmid=10751084| doi = 10.1002/(SICI)1096-8628(20000306)91:1<22::AID-AJMG4>3.0.CO;2-3|citeseerx=10.1.1.605.5548 }}</ref>

A distinct form of scleroderma and systemic sclerosis may develop in patients with [[chronic kidney failure]]. This form, [[nephrogenic fibrosing dermopathy]] or nephrogenic systemic fibrosis,<ref name="pmid20299369">{{cite journal |vauthors=Abdel-Kader K, Patel PR, Kallen AJ, Sinkowitz-Cochran RL, Bolton WK, Unruh ML |title=Nephrogenic Systemic Fibrosis: A Survey of Nephrologists' Perceptions and Practices |journal=Clin J Am Soc Nephrol |volume= 5|issue= 6|pages= 964–71|date=March 2010 |pmid=20299369 |pmc=2879309 |doi=10.2215/CJN.00140110 |url=http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20299369}}</ref><ref name="pmid20120045">{{cite journal |title=[Nephrogenic systemic fibrosis or kidney failure--how great is the risk?] |language=de |journal=Rofo |volume=182 |issue=2 |pages=114–5 |date=February 2010 |pmid=20120045 }}</ref><ref name="pmid20118047">{{cite journal |vauthors=Panos A, Milas F, Kalakonas S, Myers PO |title=Cardiac autotransplantation for aortic and mitral valve replacement in a patient with nephrogenic systemic fibrosis |journal=Hellenic J Cardiol |volume=51 |issue=1 |pages=64–6 |year=2010 |pmid=20118047 |url=http://www.hellenicjcardiol.org/archive/full_text/2010/1/2010_1_64.pdf}}</ref><ref name="pmid20063400">{{cite journal |vauthors=Fine DM, Perazella MA |title=Nephrogenic systemic fibrosis: what the hospitalist needs to know |journal=J Hosp Med |volume=5 |issue=1 |pages=46–50 |date=January 2010 |pmid=20063400 |doi=10.1002/jhm.493}}</ref> has been linked to exposure to [[gadolinium]]-containing [[radiocontrast]].<ref>{{cite journal |vauthors=Boyd AS, Zic JA, Abraham JL |title=Gadolinium deposition in nephrogenic fibrosing dermopathy |journal=J. Am. Acad. Dermatol. |volume=56 |issue=1 |pages=27–30 |year=2007 |pmid=17109993 |doi=10.1016/j.jaad.2006.10.048}}</ref>

[[Bleomycin]]<ref>{{cite journal  |vauthors=Sharma SK, Handa R, Sood R, etal |title=Bleomycin-induced scleroderma |journal=The Journal of the Association of Physicians of India |volume=52 |pages=76–7 |year=2004 |pmid=15633728 }}</ref> (a chemotherapeutic agent) and possibly [[taxane]] chemotherapy<ref>{{cite journal |vauthors=Farrant PB, Mortimer PS, Gore M |title=Scleroderma and the taxanes. Is there really a link? |journal=Clin. Exp. Dermatol. |volume=29 |issue=4 |pages=360–2 |year=2004 |pmid=15245529 |doi=10.1111/j.1365-2230.2004.01519.x|s2cid=11105198 }}</ref> may cause scleroderma, and occupational exposure to [[solvent]]s has been linked to an increased risk of systemic sclerosis.<ref>{{cite journal  |vauthors=Kettaneh A, Al Moufti O, Tiev KP, etal |title=Occupational exposure to solvents and gender-related risk of systemic sclerosis: a metaanalysis of case-control studies |journal=J. Rheumatol. |volume=34 |issue=1 |pages=97–103 |year=2007 |pmid=17117485 }}</ref>