Background Systemic sclerosis (SSc) is a chronic, autoimmune and progressive connective tissue disease characterized by widespread vascular and fibrotic changes in the skin and internal organs. Musculoskeletal involvement is frequent in patients with SSc and may be the presenting manifestation of the disease which may also causes significant functional disability. Enthesitis is characteristic feature of spondyloarthritis including ankylosing spondylitis and psoriatic arthritis however the prevalence and clinical relevance of enthesitis is not known in patients with SSc.
Objectives The aim of this study was to investigate the presence of enthesitis in patients with SSc by using Doppler ultrasonography.
Methods Patients met 2013 ACR/EULAR classification criteria for SSc were included. All patients were female. Patients and age-matched healthy women underwent ultrasonographic examination using Logic P5 (GE Medical Systems, UK) with a linear probe (7–12 MHz). The Madrid Sonography Enthesitis Index (MASEI) was used to score 6 entheses sites.
Results We evaluated 6 entheses in 40 patients with SSc (mean age 48±12.8 years) and 40 healthy controls (49.3±9.3 years). Mean disease duration and diagnostic delay was 10.1 and 6.0 years, respectively. In SSc group, there was 20 (50%) diffuse cutaneous SSc, 16 (40%) limited cutaneous SSc, 2 (2.5%) sine SSc and 2 (2.5%) overlap syndromes. Demographic and clinical features were similar between dcSSc and lcSSc. Patients had higher mean MASEI score compared to controls (16.1±9.7 vs 2.0±2.3, p<0.0001). Thickness of the triceps, quadriceps, Achilles tendons as well as proximal and distal patellar ligaments were higher in patients compared to controls. MASEI scores correlated positively with age (r:0.29, p:0.008), modified Rodnan skin score (r:0.49, p:0.002), pulmonary involvement grade (r:0.35, p:0.037) and inversely with hand grip strength (r:-0.48, p:0.004). Thickness of left plantar aponeurosis positively correlated with age (r:0.28, p:0.012) and BMI (r:0.24, p:0.032). Doppler sonographic features of the entheses are presented in Table 1.
Conclusions To the best of our knowledge this is the first study showing the high prevalence of enthesitis in patients with SSc assessed by Doppler ultrasonography. Enthesitis is an important musculoskeletal manifestation in patients with SSc and could be identified by using Doppler ultrasonography.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.