Background Articular manifestations are common in systemic sclerosis (SSc), and joint pain is a frequent presenting feature of this disease. Joint symptoms have been noted in 12 to 66% of patients at the time of diagnosis and in 24 to 97% of patients at some time during the course of their illness.
Objectives To determine frequency and features of erosive and non erosive arthritis in a prospective study of systemic sclerosis patients
Methods One hundred fifty (150) patients attending the rheumatology department at Ben Aknoun Hospital, as part of a prospective study and fulfilling the ACR and/or Leroy and Medsger criteria for systemic sclerosis were evaluated by one author.
Joint involvement was classified as follows: arthralgias, arthritis (joint swelling and tenderness on physical examination or synovitis on US), erosive arthritis (erosions and joint space narrowing on radiographs or erosions on US). Only wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were studied.
Standard radiographs of the hands and wrists were obtained and evaluated. All radiographs were evaluated without knowledge of the clinical or serological data of the patients examined.
The presence of either extra-articular (subcutaneous calcinosis and digital tuft resorption) or articular involvement (juxta-articular osteoporosis, marginal erosions and joint space narrowing) was recorded. Ultrasonography (US) of the wrists, the MCP and the PIP was performed in patients without arthritis on joint examination or with normal radiographs. All autoantibody analyses were performed in the Laboratory of Beni Messous hospital, Algiers, Algeria.
The statistical significance for the various associations was calculated using the X2 test. The difference was significant when p value < 0.05.
Results 139 women and 11 men with a median age of 45.12±13.59 years and a disease duration (first non-Raynaud symptom) of 9.7 years. 42 patients had a diffuse scleroderma, 108 patients had a limited scleroderma.
60 patients had arthritis. Arthritis were inaugural in 41.7%. There was no significant difference between patients with or without arthritis in term of digital ulcers, skin, lung, heart and kidney involvement. Anti-CCP2 was positive in 16.5% patients with arthritis and in 4.5% patients without arthritis (p=0.01)
21 patients had erosive arthritis, An overlap with Rheumatoid Arthritis (RA) was found in only 7 patients.
Patients with erosive arthritis had more diffuse cutaneous involvement (42.9%) (p=0.01), digital ulcers (81%) (p = 0.009) and ILD (81%) (p=0.009). Anti-CCP2 was positive in 33.3 % patients with erosive arthritis and in 7.7 % patients without erosive arthritis (p = 0.01). Anti-topoisomerase 1 antibody was positive in 71.4 % patients with erosive arthritis and in 38.5 % patients without erosive arthritis (p = 0.01).
We also compared patients with erosive arthritis, with and without overlap syndrome (SSc-RA)
14 patients had erosive arthritis but no RA. Those patients had more flexion contracture (92.9%) (p=0.01), digital ulcers (92.9%) (p=0.04), acro-osteolysis (50%) (p=0.04), esophagus involvement (100%) (p=0.03) and ILD (92.9%) (p=0.04).
Conclusions Erosive arthritis and particularly systemic sclerosis erosive arthropathy was associated with a severe disease.
Disclosure of Interest: None Declared
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