Background Systemic sclerosis (SSc, scleroderma) is a systemic disease characterized by fibrosis, progressive vascular obliteration and the production of autoantibodies.Ultrasound (US) imaging has advantages of simplicity, low cost, noninvasiveness, real-time capability and portability compared with traditional EDX. US imaging also offers high temporal and spatial resolutions, and can potentially provide dynamic anatomical information regarding local structures and kinesiology, few studies evaluate joint and tendons involvement in SSc by US the incidence and abnormality are differs among studies
Objectives describe and determine possible correlations between US abnormalities of hand and wrist and clinical findings in SSc Egyptian patients
Methods Randomly selected 50 Egyptian SSc patients were enrolled in the study in outpatient clinic Rheumatology department, Assuit university hospital. Clinical examination and US evaluation (Gray Scale and Power Doppler (PD)) of the tendons and joints of hands and wrists, were performed bilaterally on both dorsal and palmar sides. Joint assessment was performed on all MCP and PIP joints as well as the wrist and tendon assessment included finger flexors and extensors, wrist extensors and flexors. The scoring for synovitis was based on the EULAR/ OMERACT scoring system
Results Within the cohort, 100% of the patients were female; mean age and range disease duration were 40.93±11.71 (20–61) years and 8.13±5.56 (0.5–25)years, respectively. Modified Rodnan Skin Score mean and range were 23.17±9.14 (13–43), 22 patients were diffuse type (44%) and 28 patients were limited type (56%), 67% had inflammatory arthralgia as reported by patients. US examination revealed abnormalities in 76% of all cases. Synovitis was present in 74% of patients (22% wrist; 15% MCP/PIP, 63% both); with a grade 2 and 3 synovitis in 29% cases. The grade 2 or 3 synovitis was associated with a higher age (p<0.05) and disease duration (p<0.03) but not with inflammatory markers (CRP, ESR) and C3 nor with anti-CCP antibodies.
Furthermore, patients with US proven grade 2 or 3 synovitis had interstitial lung disease involvement (ILD) (74%) and elevated systolic pulmonary artery pressure >35 mmHg in (46%). Grade 1 synovitis did not correlate with tenderness or joint swelling. Synovitis using PD abnormalities were present in 20% patients, but only a 25% had concomitant clinical synovitis. Bone erosions (>1mm) were observed in 15%, which located at the second and third MC heads and at the styloid process of the ulna. The presence of bone erosions was associated with the presence of grade 2 or 3 synovitis. US identified tenosynovitis in 40% of patients, involving the wrist extensors in the vast majority of cases (70%), especially of the 2nd extensor compartment.
Conclusions US examination detects significant synovitis of the hand and wrist in the absence of clinical findings, and reveals structural damage in a number of patients. The grade 2 or 3 synovitis was associated with a higher age, and ILD involvement. Tendon involvement is frequent with specific pattern of wrist extensors. Thus, US seems to be a valuable tool to identify subclinical joint manifestations in Egyptian SSc patients.
Disclosure of Interest None declared