Radiological hand involvement in systemic sclerosis
- 1Department of Rheumatology A, René Descartes University, School of Medicine, Cochin Hospital, Paris, France
- 2Department of Radiology B, René Descartes University, School of Medicine, Cochin Hospital
- Correspondence to:
Dr Allanore Yannick
Hôpital Cochin, Service de rhumatologie A, 27 rue du faubourg Saint Jacques, 75014 Paris, France;
- Accepted 30 December 2005
- Published Online First 13 January 2006
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.
- ACR, American College of Rheumatology
- AKA, anti-keratin antibodies
- DIP, distal interphalangeal joint
- HAQ, Health Assessment Questionnaire
- PAH, pulmonary arterial hypertension
- RF, rheumatoid factor
- SSc, systemic sclerosis
Published Online First 13 January 2006