title: The "sclerodermic hand": a radiological and clinical study.
abstract: OBJECTIVE
  To assess the clinical and radiographic features of hand involvement in patients with systemic sclerosis (SSc).
  
  
  METHODS
  Forty-one unselected Sardinian SSc patients (32 women, 9 men; mean age 58.9, range 31-81 years; mean disease duration 11.8 years, range 1-36 years) were evaluated in this observational cross-sectional study. Twenty-six patients had diffuse scleroderma (dSSc) and 15 limited scleroderma (lSSc). Radiological examination of the hands was performed and the films were read by two independent rheumatologists blinded to the diagnosis using a classification system of four predefined radiological patterns (normal/minimal changes, articular degenerative, articular inflammatory and periarticular pattern). Correlations between radiological pattern, clinical and serological features were assessed.
  
  
  RESULTS
  The skeletal and articular involvement of the hand was frequent in SSc, being clinically evident in 30/41 (73%) and radiologically in 33/41 (80%) of patients. The periarticular pattern (defined as the occurrence of bone resorption of ungueal tufts, soft tissue calcifications and/or flexion deformities) was the most frequent pattern detected (14/41, 34.1%) and finger flexion contractures and bone resorptions were significantly associated with interstitial lung disease, reduced FVC, oesophagus involvement and prostacycline therapy. Calcinosis (29.2%) was found to be associated with erosions, suggesting a pathogenic link. An inflammatory pattern was also radiologically frequent (8/41, 19.5%), but erosions, with the exception of those localized at distal interphalangeal joints, were demonstrated mainly in patients with clinical picture of rheumatoid arthritis overlapped with SSc. We found no significant differences in terms of radiographic findings between lSSc and dSSc with the exception of calcinosis, which was more frequent in patients with lSSc.
  
  
  CONCLUSIONS
  This cross-sectional study confirms that the skeletal and articular involvement of the hand is frequent in SSc.
authors.affiliation: Cattedra di Reumatologia, University of Sassari, V. le San Pietro 8, 07100 Sassari, Italy. e.gianluca@libero.it
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Erre
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marongiu
authors.forename: Patrizia
authors.initials: P
authors.lastname: Fenu
authors.forename: Rossana
authors.initials: R
authors.lastname: Faedda
authors.forename: Antonello
authors.initials: A
authors.lastname: Masala
authors.forename: Marcella
authors.initials: M
authors.lastname: Sanna
authors.forename: Giovanni
authors.initials: G
authors.lastname: Soro
authors.forename: Andreina
authors.initials: A
authors.lastname: Tocco
authors.forename: Daniela
authors.initials: D
authors.lastname: Piu
authors.forename: Daniela
authors.initials: D
authors.lastname: Marotto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Passiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging*