Background Musculoskeletal involvement, preferentially affecting hands and feet, represents a frequent feature and may lead to disability in patients with systemic sclerosis (SSc). The most common manifestations are arthralgia, stiffness, synovitis, and tenosynovitis. In a large multicentre study, synovitis, tendon friction rubs, and joint contractures were found in 16%, 11%, and 31% of 7286 SSc patients assessed by clinical examination 1. However, several ultrasound (US) studies revealed a higher frequency of hand joint involvement 2.
Objectives To investigate the frequency and severity of hand joint involvement in a cohort of SSc patients evaluated by US, and to compare the results of US synovitis detection with those of physical examination.
Methods Over a 6-month period, all consecutive (new and old diagnosis) SSc patients (ACR/EULAR 2013 criteria) currently followed in our center underwent clinical and US hand examination. One rheumatologist expert in musculoskeletal US performed all examinations by using Esaote Technos MPX, MyLab 40, employing high frequency (12–18 MHz) transducers. Power Doppler (PD) parameters were adjusted (range of pulse repetition frequency 400–800 Hz; frequency 7–11.1 MHz). Patients were scheduled to be examined at the same hour of the day in the same room with an ambient temperature of 21°C. Hand and wrist joints were evaluated for synovitis, tenosynovitis, calcinosis, acro-osteolysis and distal vascularization. An independent rheumatologist made the clinical examination and US examiner was blind to clinical findings. US assessment of synovitis was scored according to the OMERACT–EULAR PD composite semiquantitative scale (0–3).
Results 89 patients, 79F/10M, mean age 61.11±15.1, median disease duration 160 months (min: 2,max: 492), 83 (93%) with limited SSc and 6 (7%) with diffuse SSc were recruited. Synovitis was detected in 15 (16.8%) and in 35 (40.2%) of the cases by clinical examination and US, respectively (p=0.019). PD revealed grade 1 synovitis in 19/35 (54.3%) patients, grade 2 in 14 (40%) and grade 3 in 2 (5.7%). Tenosynovitis, calcinosis and acro-osteolysis were found at US 19 (21.3%), 14 (15.7%), acro-osteolysis in 11 (12.3%) and 8 (9%), respectively. Distal vascularization was detected in 60 patients (67%).
Conclusions Confirming previous studies, our results show that hand synovitis in SSc may be underestimated by clinical examination only, while US examination provides an accurate assessment of the frequency and the degree of severity of synovial inflammation. However, synovitis in our cohort of SSc patients resulted mild in the majority of the cases.
Avouac J, et al. J Rheumatol. 2010;37:1488–501.2.Cuomo G, et al. Rheumatology (Oxford) 2009;48:1414–1417.
Disclosure of Interest None declared
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