(76〜79题共用题干）女性，49岁。以“双手及颜面皮肤肿胀、变硬6个月”来诊。査体:手指及面部皮肤增厚，皮肤紧绷，嘴唇变薄，张口受限。手指肿胀，呈“腊肠样”，指端发绀，关节活动受限。实验室检査:血、尿常规正常，肝肾功能正常，ANA阳性。本病的常见首发症状是

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