Background Magnetic resonance imaging (MRI) is useful method for detection and quantification of subclinical synovial inflammation and joint damage with better precision than radiography in systemic sclerosis (SSc). Early aggressive treatment of inflammation may prevent joint damage and improve the outcomes
Objectives To determine and quantify synovial inflammation by MRI in SSc; to examine the relationship of MRI findings with clinical and radiography features
Methods 82 scleroderma patients (77 women and 5 male, mean age 54y,) underwent low field MR imaging with gadolinium at the dominant (clinically most active) hand including wrist and MCP joints 2-5. Assessment of bone marrow edema, synovitis, bone erosions and tenosynovitis was performed by the OMERACT RA MRI scoring system. Clinically features of musculoskeletal manifestations- articular or periarticular pain, joint contractures, swelling were recorded. Standard AP radiographs of the hand and wrist were obtained in 2 planes. Radiologically, we recorded articular (joint space narrowing-JSN, erosions, synovitis), soft tissue (calcification, tenosynovitis) and bone (osteopenia, bone resorption) changes
Results 14/82 (17,1%) pts had clinically arthritis; 66/82 pts (80,5%) had arthralgias. Of 82% with scleroderma, 65/82 (79,3%) had inflammatory MR findings with synovitis in 64/82 (78%), erosions in 52 (63,4%) or tenosynovitis in 11 pts (14,1%) Synovitis was more frequently detected on MRI (78%) than clinically (17,1%), p<0,001. Of 52 pts (63,4%) with MRI erosions, only 22 (27,5%) had radiographic erosions (p<0,01). There was no statistically significant difference in prevalence of joint contractures by clinical examination- 28pts, 34,1% compared to radiography- 25pts, 32,1%, p=0,617. There was no difference, also, between clinical and MRI finding of tenosynovitis in SSc pts (p=0,617). Applying the OMERACT RAMRIS system, there was no difference between mean synovitis, erosion and oedema score between limited and diffuse SSc subtypes (synovitis, wrist: p=0,222, MCP: p=0,443; erosions, wrist:p=0,371, MCP:p=0,281; oedema, wrist: p=0,229; MCP: p=0,651).
Conclusions MRI is more sensitive method than clinical examination and radiological finding of inflammation in scleroderma. Our study demonstrate the presence of persistant inflammatory, erosive arthropathy of the hand in SSc patients. RAMRIS scoring system, used in RA, also can be used to quantify the inflammatory arthritis in SSc
Disclosure of Interest None Declared
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