Problem: A 54-year-old woman presents to the clinic with fatigue, dysphagia, a nonproductive cough, stiffness in the joints in her hands, and tightness in her fingers. Additionally, she explains that her fingers occasionally become pale and painful when she forgets to wear gloves on cold days. On physical examination, her skin is taut and thickened over her hands (see below) and face. Her hands appear claw-like and have decreased motion at all of the small joints symmetrically. 1. What diagnosis does the nurse anticipate?