title: A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis.
abstract: OBJECTIVE
  To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc).
  
  
  METHODS
  The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed.
  
  
  RESULTS
  A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints.
  
  
  CONCLUSIONS
  Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.
authors.affiliation: Department of Rheumatology and Immunology Clinic Centre, University of Pécs, Hungary. balint.zsofia@pte.hu.
authors.forename: Z
authors.initials: Z
authors.lastname: Bálint
authors.forename: H
authors.initials: H
authors.lastname: Farkas
authors.forename: N
authors.initials: N
authors.lastname: Farkas
authors.forename: T
authors.initials: T
authors.lastname: Minier
authors.forename: G
authors.initials: G
authors.lastname: Kumánovics
authors.forename: K
authors.initials: K
authors.lastname: Horváth
authors.forename: A I
authors.initials: AI
authors.lastname: Solyom
authors.forename: L
authors.initials: L
authors.lastname: Czirják
authors.forename: C
authors.initials: C
authors.lastname: Varjú
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003286:Contracture / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D050823:Hand Joints / Q000503:physiopathology; D006616:Hip Contracture / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D016014:Linear Models; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D045743:Scleroderma, Diffuse / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D045745:Scleroderma, Limited / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D012595:Scleroderma, Systemic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology; D014797:Vital Capacity
chemical_list: D002097:C-Reactive Protein