RESEARCH - Radiological hand involvement in systemic sclerosis

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Ann Rheum Dis. 2006 Aug;65(8):1088-92. Epub 2006 Jan 13.

Radiological hand involvement in systemic sclerosis.

Avouac J, Guerini H, Wipff J, Assous N, Chevrot A, Kahan A, Allanore Y.

Service de rhumatologie A, Hopital Cochin, 27 rue du faubourg Saint Jacques,

75014 Paris, France.

BACKGROUND: The osteoarticular and soft tissue structures of the hand may be

involved in systemic sclerosis (SSc), causing functional disability.

OBJECTIVE: To assess radiological hand features in a cross sectional study

of SSc patients and in controls. METHODS: Hand radiology was done

systematically in patients with SSc seen over a two year period and in

unselected controls with rheumatoid arthritis or digital trauma. Two

independent investigators blind to the diagnosis carried out the

radiological assessment. RESULTS: 120 consecutive SSc patients (median

(range) age, 56.5 (20 to 90) years; disease duration, 6 (0 to 42) years) and

42 controls (22 with rheumatoid arthritis and 20 with digital trauma) were

studied. Radiological abnormalities in SSc patients included erosion (21%),

joint space narrowing (28%), arthritis (defined by concomitant erosion and

joint space narrowing) (18%), radiological demineralisation (23%),

acro-osteolysis (22%), flexion contracture (27%), and calcinosis (23%). In

univariate and multivariate analysis, the resorption of distal phalanges was

significantly associated with digital ulcers, extra-articular calcification,

and pulmonary arterial hypertension; flexion contracture was associated with

the diffuse cutaneous form and high HAQ (Health Assessment Questionnaire)

disability score. Calcinosis was most often seen in patients with digital

ulcers, but was similarly observed in patients with the diffuse or limited

cutaneous subtypes.

CONCLUSIONS: Flexion contracture was associated with disability and occurred

in patients with the diffuse cutaneous subtype of SSc, consistent with the

tendency towards fibrosis and functional impairment of this subtype.

Calcinosis and acro-osteolysis were both associated with vascular

complications, highlighting a potential role of vascular injury in such

lesions.

PMID: 16414976

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6414976

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