Indication of poor prognosis of systemic sclerosis is:

* Patients with diffuse, rapid skin involvement have the highest risk of developing scleroderma renal crisis. Renal crisis occurs in about 10% of all patients with systemic sclerosis and is indicative of bad prognosis. * Renal crisis presents as accelerated hypeension, oliguria, headache, dyspnea, edema, and rapidly rising serum creatinine levels. * Renal crisis is observed within 4 years of diagnosis in about 75% of patients but may develop as late as 20 years after diagnosis. * Avoid high doses of coicosteroids since this is a significant risk factor for renal crisis.