title: Power Doppler ultrasound of the hand and wrist joints in systemic sclerosis.
abstract: OBJECTIVE
  This paper aims to investigate the prevalence and severity of hand and wrist joints power Doppler (PD) ultrasound (US) detected abnormalities in systemic sclerosis (SSc).
  
  
  METHODS
  Hand and wrist joints of 46 consecutive SSc patients and 15 healthy controls were studied by using PDUS. Each joint was evaluated for the presence of effusion, synovial hypertrophy, hyperaemia, bone erosions and cortical irregularities; in addition, local tendons for tenosynovitis and hyperaemia, and median nerve for entrapment neuropathy were examined.
  
  
  RESULTS
  Synovial hypertrophy was detected in 3% hand joints and in 46% wrists of SSc patients, with significant differences respect to controls (p=0.000004 and 0.000001, respectively). The prevalence of PD positivity was significantly higher in patients' hand joints (1.7%, p=0.001527) and wrists (43%, p=0.000001) than in healthy individuals. Seven percent of hand and 54% of wrist joints resulted to be positive for joint effusion with significant differences from controls (p=0.000001 and p=0.000013, respectively). The prevalence of cortical irregularities was significantly higher (p=0.006) than healthy subjects only at hand joints level. No significant difference was found for bone erosions. Tenosynovitis was found in 6% out of the 1.196 synovial tendon sites examined of SSc patients with significant differences compared to healthy subjects (p=0.000001); PD resulted to be positive in 29% of them, with significantly differences compared to controls (p=0.0038).
  
  
  CONCLUSIONS
  This study, focused on hand and wrist joints PDUS assessment of inflammatory and structural abnormalities in SSc, demonstrated a varied and complex involvement both at joint and periarticular tissues level, showing that wrists were more frequently the site of inflammatory findings.
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy. annamaria.iagnocco@uniroma1.it
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Caterina
authors.initials: C
authors.lastname: Vavala
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Vasile
authors.forename: Katia
authors.initials: K
authors.lastname: Stefanantoni
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
authors.forename: Valeria
authors.initials: V
authors.lastname: Riccieri
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012720:Severity of Illness Index; D013717:Tenosynovitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018608:Ultrasonography, Doppler / Q000379:methods*; D014955:Wrist Joint / Q000000981:diagnostic imaging*