Which symptom is not part of CREST syndrome?

• A. Arthralgia
• B. Calcinosis
• C. Raynaud phenomenon
• D. Esophageal dysmotility

Answer: (D)

CREST represents the limited form of systemic sclerosis and includes five hallmark features: calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. Among the options, the symptom not part of CREST is arthralgia. Joint pains can occur with scleroderma, but they are not one of the defining CREST features. The others fit squarely: calcinosis is calcium deposits in the skin, Raynaud phenomenon is a vasospastic color change in the digits, esophageal dysmotility comes from fibrosis of the esophageal smooth muscle leading to reflux and dysphagia, sclerodactyly is thickening and tightening of the skin on the fingers, and telangiectasia are small dilated blood vessels.