The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study.
OBJECTIVE
To assess the clinical and radiological features of systemic sclerosis (SSc) joint involvement in a prospective cross-sectional study.


METHODS
Seventy-six consecutive patients with SSc divided into clinical and serological subsets were investigated. Clinical and radiological assessments of the hands and feet were carried out. Three radiological patterns of inflammatory, degenerative and fibrotic changes were predefined. The Health Assessment Questionnaire (HAQ) disability index (DI) and individual components of the HAQ-DI were also evaluated.


RESULTS
The highest impairments on the HAQ-DI (median 0.44; range 0-2.87) were detected in subdimensions such as hygiene, grip and activity components. Clinically articular involvement, arthralgia and finger contractures were seen more frequently than arthritis, and a significantly higher prevalence of finger flexion was found in patients with diffuse cutaneous SSc (P=0.03) compared with the other SSc subtypes. Radiologically, distal interphalangeal joint space narrowing and flexion deformity indicating periarticular fibrosis were frequently detected. Juxta-articular osteoporosis, joint space narrowing and flexion contractures of the fingers were seen significantly more frequently in the hands. A significantly higher frequency of fibrotic pattern were found in the hands whereas a degenerative pattern was more frequent in the feet (P<0.05). Finally, significant correlations were detected between flexion contractures and a radiological fibrotic pattern (P<0.001), and the severity scores of peripheral vascular impairment (P=0.026) and skin (P=0.007).


CONCLUSIONS
This cross-sectional prospective study confirms that an arthropathy is common in SSc patients and shows that it is a major determinant of disability. A classification of radiological alterations into three specific patterns is proposed.
La Montagna
Giovanni
G
Dipartimento Medico-Chirurgico di Internistica, Clinica e Sperimentale F Magrassi e A Lanzara, Unità Operativa di Reumatologia, Seconda Università di Napoli, 80131 Naples, Italy. giovanni.lamontagna@unina2.it
Sodano
Antonio
A
Capurro
Vittorio
V
Malesci
Domenico
D
Valentini
Gabriele
G
D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D003286:Contracture / Q000000981:diagnostic imaging / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D005500:Follow-Up Studies; D005528:Foot / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D006920:Hygiene; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000503:physiopathology; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology