Radiological hand involvement in systemic sclerosis.
BACKGROUND
The osteoarticular and soft tissue structures of the hand may be involved in systemic sclerosis (SSc), causing functional disability.


OBJECTIVE
To assess radiological hand features in a cross sectional study of SSc patients and in controls.


METHODS
Hand radiology was done systematically in patients with SSc seen over a two year period and in unselected controls with rheumatoid arthritis or digital trauma. Two independent investigators blind to the diagnosis carried out the radiological assessment.


RESULTS
120 consecutive SSc patients (median (range) age, 56.5 (20 to 90) years; disease duration, 6 (0 to 42) years) and 42 controls (22 with rheumatoid arthritis and 20 with digital trauma) were studied. Radiological abnormalities in SSc patients included erosion (21%), joint space narrowing (28%), arthritis (defined by concomitant erosion and joint space narrowing) (18%), radiological demineralisation (23%), acro-osteolysis (22%), flexion contracture (27%), and calcinosis (23%). In univariate and multivariate analysis, the resorption of distal phalanges was significantly associated with digital ulcers, extra-articular calcification, and pulmonary arterial hypertension; flexion contracture was associated with the diffuse cutaneous form and high HAQ (Health Assessment Questionnaire) disability score. Calcinosis was most often seen in patients with digital ulcers, but was similarly observed in patients with the diffuse or limited cutaneous subtypes.


CONCLUSIONS
Flexion contracture was associated with disability and occurred in patients with the diffuse cutaneous subtype of SSc, consistent with the tendency towards fibrosis and functional impairment of this subtype. Calcinosis and acro-osteolysis were both associated with vascular complications, highlighting a potential role of vascular injury in such lesions.
Avouac
J
J
Service de rhumatologie A, Hôpital Cochin, 27 rue du faubourg Saint Jacques, 75014 Paris, France.
Guerini
H
H
Wipff
J
J
Assous
N
N
Chevrot
A
A
Kahan
A
A
Allanore
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005383:Finger Injuries / Q000150:complications / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging*; D012883:Skin Ulcer / Q000150:complications / Q000000981:diagnostic imaging