Radiological hand involvement in systemic sclerosis

Jerome Avouac ¹, Henri Guerini ², Julien Wipff ¹, Noemie Assous ¹, Alain Chevrot ³, Andre Kahan ¹ and Yannick Allanore ^1*

¹ Rheumatology A, Paris Descartes University, Medical Faculty, Cochin Hospital, AP-HP, Paris, France
² Radiology B, Paris-Descartes University, Medical Faculty, Cochin Hospital, AP-HP, Paris, France
³ Radiology B, Paris Descartes University, Medical Faculty, Cochin Hospital, AP-HP, Paris, France

^* To whom correspondence should be addressed. E-mail: yannick.allanore{at}cch.aphp.fr.

Accepted 30 December 2005

Abstract

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 X rays were systematically performed for patients with SSc seen over a two-year period and unselected controls with rheumatoid arthritis or digital trauma. Two independent investigators blind to the diagnosis carried out radiological assessment.

Results: 120 consecutive SSc patients (median [range] age of 56.5 [20-90] years, median [range] disease duration of 6 [0-42] years) and 42 controls (22 with rheumatoid arthritis and 20 with digital trauma) were included. 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 calcifications and pulmonary arterial hypertension; flexion contracture was associated with the diffuse cutaneous form and high HAQ disability score. Calcinosis was most frequently seen in patients with digital ulcers, but was also observed in patients with the diffuse or limited cutaneous subtypes.

Conclusion: Flexion contracture was associated with disability and occurred in patients with the diffuse cutaneous subtype, 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.

Keywords: acroosteolysis, calcinosis, hand,, osteo-articular, systemic sclerosis

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