Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database.
OBJECTIVE
To determine the prevalence of and independent factors associated with joint involvement in a large population of patients with systemic sclerosis (SSc).


METHODS
This study was cross-sectional, based on data collected on patients included in the European League Against Rheumatism (EULAR) Scleroderma Trials and Research (EUSTAR) registry. We queried this database to extract data regarding global evaluation of patients with SSc and the presence of any clinical articular involvement: synovitis (tender and swollen joints), tendon friction rubs (rubbing sensation detected as the tendon was moved), and joint contracture (stiffness of the joints that decreased their range of motion). Overall joint involvement was defined by the occurrence of synovitis and/or joint contracture and/or tendon friction rubs.


RESULTS
We recruited 7286 patients with SSc; their mean age was 56 +/- 14 years, disease duration 10 +/- 9 years, and 4210 (58%) had a limited cutaneous disease subset. Frequencies of synovitis, tendon friction rubs, and joint contractures were 16%, 11%, and 31%, respectively. Synovitis, tendon friction rubs, and joint contracture were more prevalent in patients with the diffuse cutaneous subset and were associated together and with severe vascular, muscular, renal, and interstitial lung involvement. Moreover, synovitis had the highest strength of association with elevated acute-phase reactants taken as the dependent variable.


CONCLUSIONS
Our results highlight the striking level of articular involvement in SSc, as evaluated by systematic examination in a large cohort of patients with SSc. Our data also show that synovitis, joint contracture, and tendon friction rubs are associated with a more severe disease and with systemic inflammation.
Avouac
Jerome
J
Service de Rhumatologie A, Hôpital Cochin, Université Paris Descartes, 75014 Paris, France.
Walker
Ulrich
U
Tyndall
Alan
A
Kahan
André
A
Matucci-Cerinic
Marco
M
Allanore
Yannick
Y
Miniati
I
I
Muller
A
A
Iannone
F
F
Distler
O
O
Becvar
R
R
Sierakowsky
S
S
Kowal-Bielecka
O
O
Coelho
P
P
Cabane
J
J
Cutolo
M
M
Shoenfeld
Y
Y
Valentini
G
G
Rovensky
J
J
Riemekasten
G
G
Vlachoyiannopoulos
P
P
Caporali
R
R
Jiri
S
S
Inanc
M
M
Zimmermann Gorska
I
I
Carreira
P
P
Novak
S
S
Czirjak
L
L
Oliveira Ramos
F
F
Jendro
M
M
Chizzolini
C
C
Kucharz
E J
EJ
Richter
J
J
Cozzi
F
F
Rozman
B
B
Mallia
C M
CM
Gabrielli
A
A
Farge
D
D
Kiener
H P
HP
Schöffel
D
D
Airo
P
P
Wollheim
F
F
Martinovic
D
D
Trotta
F
F
Jablonska
S
S
Reich
K
K
Bombardieri
S
S
Siakka
P
P
Pellerito
R
R
Bambara
L M
LM
Morovic-Vergles
J
J
Denton
C
C
Hinrichs
R
R
Van den Hoogen
F
F
Damjanov
N
N
Kötter
I
I
Ortiz
V
V
Heitmann
S
S
Krasowska
D
D
Seidel
M
M
Hasler
P
P
Van Laar
J M
JM
Kaltwasser
J P
JP
Foeldvari
I
I
Juan Mas
A
A
Bajocchi
G
G
Wislowska
M
M
Pereira Da Silva
J A
JA
Jacobsen
S
S
Worm
M
M
Graniger
W
W
Kuhn
A
A
Stankovic
A
A
Cossutta
R
R
Majdan
M
M
Damjanovska Rajcevska
L
L
Tikly
M
M
Nasonov
E L
EL
Steinbrink
K
K
Herrick
A
A
Müller-Ladner
U
U
Dinc
A
A
Scorza
R
R
Sondergaard
K
K
Indiveri
F
F
Nielsen
H
H
Szekanecz
Z
Z
Silver
R M
RM
Antivalle
M
M
Espinosa
I B
IB
García de la Pena Lefebvre
P
P
Midtvedt
O
O
Launay
D
D
Valesini
F
F
Tuvik
P
P
Ionescu
R M
RM
Del Papa
N
N
Pinto
S
S
Wigley
F
F
Mihai
C
C
Sinziana Capranu
M
M
Sunderkötter
C
C
Jun
J B
JB
Alhasani
S
S
Distler
J H
JH
Ton
E
E
Soukup
T
T
Seibold
J
J
Zeni
S
S
Nash
P
P
Mouthon
L
L
De Keyser
F
F
Duruöz
M T
MT
Cantatore
F P
FP
Strauss
G
G
von Mülhen
C A
CA
Pozzi
M R
MR
Eyerich
K
K
Szechinski
J
J
Keiserman
M
M
Houssiau
F A
FA
Román-Ivorra
J A
JA
Krummel-Lorenz
B
B
Aringer
M
M
Westhovens
R
R
Bellisai
F
F
Mayer
M
M
Stoeckl
F
F
Uprus
M
M
Volpe
A
A
Buslau
M
M
Yavuz
S
S
Granel
B
B
Valderílio Feijó
A
A
Del Galdo
F
F
Popa
S
S
Zenone
T
T
Ricardo Machado
X
X
Pileckyte
M
M
Stebbings
S
S
Mathieu
A
A
Tulli
A
A
Tourinho
T
T
Souza
R
R
Acayaba de Toledo
R
R
Stamp
L
L
Solanki
K
K
Veale
D
D
Francisco Marques Neto
J
J
Bagnato
G F
GF
Loyo
E
E
Toloza
S
S
Li
M
M
Ahmed Abdel Atty Mohamed
W
W
Cobankara
V
V
Olas
J
J
Salsano
F
F
Oksel
F
F
Tanaseanu
C M
CM
Foti
R
R
Ancuta
C
C
Vonk
M
M
Caramashi
P
P
Beretta
L
L
Balbir
A
A
Chiàla
A
A
Pasalic Simic
K
K
Ghio
M
M
Stamenkovic
B
B
Rednic
S
S
Host
N
N
Pellerito
R
R
Hachulla
E
E
Furst
D E
DE
D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D007592:Joint Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D007596:Joints / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012594:Scleroderma, Localized / Q000209:etiology / Q000473:pathology*; D012595:Scleroderma, Systemic / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D013585:Synovitis / Q000209:etiology / Q000473:pathology; D013710:Tendons / Q000473:pathology