title: Acro-osteolysis in systemic sclerosis is associated with digital ischaemia and severe calcinosis.
abstract: OBJECTIVE
  Acro-osteolysis (bony resorption of the terminal digital tufts) is a well-recognized, but under-researched, manifestation of SSc. Our aim was to investigate the hypothesis that acro-osteolysis is associated with (i) the severity of digital ischaemia and (ii) the presence of calcinosis.
  
  
  METHODS
  This was a retrospective study of 101 patients with SSc in whom hand radiographs taken between 2001 and May 2008 were available for review. These radiographs were graded for severity of acro-osteolysis on a 0-4-point scale for each finger (0 = normal bone structure, 4 = severe pencilling of the terminal phalanges). From these scores, patients were subdivided into the following two groups: normal/minimal acro-osteolysis and moderate/severe acro-osteolysis. The presence or absence of calcinosis (mild, moderate or severe) was also documented.
  
  
  RESULTS
  Of the 101 patients, 68 were grouped as normal/minimal acro-osteolysis and 33 as moderate/severe acro-osteolysis. Forty-five had severe digital ischaemia: 25 (76%) of the patients with moderate/severe acro-osteolysis compared with 20 (29%) of those with normal/minimal acro-osteolysis (multifactorial analysis: P < 0.001). Patients with moderate/severe acro-osteolysis were more likely to have severe calcinosis (33% vs 13%), but this was not statistically significant after adjustment for potential confounders.
  
  
  CONCLUSIONS
  Acro-osteolysis was strongly associated with severe digital ischaemia. The potential association with severe calcinosis merits further study. Prospective studies are required to investigate acro-osteolysis as a marker of digital vascular disease progression and of treatment response.
authors.affiliation: University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Johnstone
authors.forename: Charles E
authors.initials: CE
authors.lastname: Hutchinson
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.forename: Aurelie
authors.initials: A
authors.lastname: Chevance
authors.forename: Ariane L
authors.initials: AL
authors.lastname: Herrick
mesh_terms: D030981:Acro-Osteolysis / Q000150:complications* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005385:Fingers / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult