Objectives The objective of this study was to describe for the first time the prevalence and characteristics of radiographic lesions of the hands and calcifications of the spine visible on CT scans (thoracic, thoracic-abdominal pelvic (TAP), and lumbar), in a population of patients with systemic sclerosis (SSc) (n=77) treated at the Nancy University Hospital (CHU) and to determine the relationships of these with the clinical and biological expression of the disease and its prognosis.
Methods This was a single centre, retrospective, descriptive and analytical study involving 77 patients treated in the CHU for limited cutaneous SSc (lcSSc) or diffuse cutaneous SSc (dcSSc) complying with the ACR/EULAR 2013 classification criteria and having had an X-ray examination of the hands and a thoracic, TAP or lumbar CT scan within the same year. The X-ray evaluation of the hands was performed as described by Erre G.L et al. The morphological and topographical evaluation of the calcifications was performed on 3 spinal segments: discovertebral, intracanal and posterior. The prognostic factors were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death.
Results Of the 77 patients of mean age 56.9 years (88.3% females), 55 (71%) suffered from lcSSc and 22 (29%) from dcSSc. There were statistically significantly more patients with interstitial disease on the CT scan and restrictive syndrome in the dcSSc group than in the lcSSc group. Study of the radiographic lesions revealed the following prevalences: calcinosis 26%, acro-osteolysis 20.8%, periarticular calcifications 28.6%, erosions 24.7%, narrowing 42.9%, subluxations 19.9% and flexion 27.3% of cases. Calcinosis, acro-osteolysis and periarticular calcifications were related to the duration of progression of the disease and to the onset of digital ulcers (DU) (p=0.002; p<0.001 and p=0.014). On the CT scan, the presence of calcifications was observed in the anterior segment in 62 patients (80.5%), in the canal segment in 21 patients (27.3%) (9 of which were foraminal) and in the posterior segment in 27 patients (35.1%). There was a relationship between the presence of axial calcifications and the existence of peripheral periarticular calcifications (p=0.012). From a prognostic viewpoint, the presence of calcinosis was associated with PAH (p=0.02), the existence of calcifications in the posterior segment (p=0.029) and foraminal calcifications (p=0.041) were associated with interstitial lung disease (ILD). The presence of foraminal calcifications was the only factor related to death (p=0.001).
Conclusions This study shows for the first time, a link between peripheral periarticular calcifications and spinal calcifications detected on the CT scan. These results suggest that spinal calcifications could provide an indicator of severity and predict mortality in patients suffering from SSc.
Erre GL, Marongiu A, Fenu P, Faedda R, Masala A, Sanna M, et al. The “sclerodermic hand”: a radiological and clinical study. Jt Bone Spine Rev Rhum. 2008;75(4):426–31.
Ogawa T, Ogura T, Ogawa K, et al. Paraspinal and intraspinal calcinosis: frequent complications in patients with systemic sclerosis. Ann Rheum Dis. 2009;68(10):1655–6.
Disclosure of Interest None declared
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