In assessing a client with systemic scleroderma, which finding indicates disease progression?

In the context of systemic scleroderma, finger contractures are a significant indicator of disease progression. This condition is characterized by fibrosis of the skin and internal organs, leading to a loss of skin elasticity and mobility. As the disease advances, patients often develop contractures, particularly in the fingers, due to tightening and thickening of the skin. These contractures can result in reduced range of motion and functional impairment.

Periorbital edema, while it may be associated with scleroderma, is not a definitive sign of progression as it can occur in various conditions and might not indicate severe disease advancement. Thinning of the skin can also occur with other skin conditions and does not specifically reflect worsening of scleroderma. Excessive salivation is generally not directly related to the severity of scleroderma and may be more indicative of other issues such as gastrointestinal involvement.

In summary, the presence of finger contractures is a clear manifestation of disease progression in systemic scleroderma, reflecting the underlying connective tissue changes and functional limitations that arise as the condition worsens.