Background Hand inflammatory involvement is a major feature in patients with systemic sclerosis (SSc), responsible for major disability. Magnetic resonance imaging (MRI) can identify and characterize subclinical inflammation and joint damage on hand with much greater precision than clinical, radiographic and ultrasonography assessment in SSc.
Objectives To determine the association of MR bone marrow oedema, synovitis and probability for the occurrence of listed inflammatory changes with clinical features and laboratory tests in SSc patients
Methods 112 SSc patients were tested (mean age 54y). Contrast enhanced low field MRI of the wrist and MCP2–5 joints was performed to all the pts. MRI bone marrow oedema and synovitis were assessed and scored by OMERACT RAMRIS scoring system. Age, sex, SSc type, disease duration (date of first non Raynaud symptom), Raynaud phenomenon, articular or periarticular pain, joint swelling and contractures, digital ulceration, HAQ, acroosteolysis (by standard PA radiographs of hand and wrist) pulmonary arterial hypertension (PAP>40mmHg at rest on Doppler echocardiography), pulmonary fibrosis (by CT and pulmonary function tests) and laboratory tests (antibody profile, RF, CRP, Creatine phosphokinase) and disease activity (by Valentini index) were done.
Results By multiple logistic regression analysis taking into account all clinical and laboratory variable, we found that MRI bone marrow oedema of the hand was associated and probability for the occurance of MRI bone marrow oedema was higher for the SSc pts with digital ulcers (OR=6.081;95%IP:1.295–28.550; p<0.05), HAQ>1.5 (OR=6.448; 95%IP: 1.714–24.257; p<0.01) and active disease (OR=3.377; 95%IP; 1.175–9.706; p<0.05).
MRI synovitis of the hand was associated and probability for the occurance of MRI synovitis was higher, also, for the SSc pts with digital ulcers (OR=5.128; 95%IP: 1.085–24.243; p<0.05), HAQ>1.5 (OR=9.067; 95%IP: 1.925–42.708; p<0.01) and active disease (OR=3.565; 95%IP: 1.181–10.764; p<0.05).
Conclusions MRI bone marrow oedema and synovitis on the hand in SSc are associate with digital ulcers, impaired functional capacity and active disease. Monitoring and treatment of clinical features and organ involvement are essential in all the pts with SSc, especially those with proven bone marrow oedema and synovitis on MRI of the hand.
Disclosure of Interest None declared
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