The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study
To assess the clinical and radiological features of systemic sclerosis (SSc) joint involvement in a prospective cross-sectional study.
Design and patients
Seventy-six consecutive patients with SSc divided into clinical and serological subsets were investigated. Clinical and radiological assessments of the hands and feet were carried out. Three radiological patterns of inflammatory, degenerative and fibrotic changes were predefined. The Health Assessment Questionnaire (HAQ) disability index (DI) and individual components of the HAQ-DI were also evaluated.
The highest impairments on the HAQ-DI (median 0.44; range 0–2.87) were detected in subdimensions such as hygiene, grip and activity components. Clinically articular involvement, arthralgia and finger contractures were seen more frequently than arthritis, and a significantly higher prevalence of finger flexion was found in patients with diffuse cutaneous SSc (P=0.03) compared with the other SSc subtypes. Radiologically, distal interphalangeal joint space narrowing and flexion deformity indicating periarticular fibrosis were frequently detected. Juxta-articular osteoporosis, joint space narrowing and flexion contractures of the fingers were seen significantly more frequently in the hands. A significantly higher frequency of fibrotic pattern were found in the hands whereas a degenerative pattern was more frequent in the feet (P<0.05). Finally, significant correlations were detected between flexion contractures and a radiological fibrotic pattern (P<0.001), and the severity scores of peripheral vascular impairment (P=0.026) and skin (P=0.007).
This cross-sectional prospective study confirms that an arthropathy is common in SSc patients and shows that it is a major determinant of disability. A classification of radiological alterations into three specific patterns is proposed.
KeywordsSystemic sclerosis Arthropathy HAQ-DI Clinical subsets Serological subsets Radiological patterns
- 1.Medsger TA Jr. Systemic sclerosis (scleroderma): clinical aspects. In: Koopman WJ, ed. Arthritis and allied conditions, 14th edn. Philadelphia: Lippincott Williams & and Wilkins, 2001:1590–1624.Google Scholar
- 2.Blocka K. Organ involvement: musculoskeletal. In: Clements PJ, Furst D, eds. Systemic sclerosis. Philadelphia: Williams & Wilkins, 1996:411–424.Google Scholar
- 3.Seibold JR. Scleroderma and mixed connective tissue diseases. In: Ruddy S, Harris ED, Sledge CB, eds. Kelley’s textbook of rheumatology, 6th edn. Philadelphia: WB Saunders, 2001:1211–1239.Google Scholar
- 4.Zimmerman C, Steiner G, Skriner K, Hassfeld W, Petera P, Smolen JS. The concurrence of rheumatoid arthritis and limited systemic sclerosis: clinical and serologic characteristics of an overlap syndrome. Arthritis Rheum 1998; 41:1938–1945.Google Scholar
- 8.Ferri C, Valentini G, Cozzi F, et al. Systemic Sclerosis Study Group of the Italian Society of Rheumatology (SIR-GSSSc). Systemic sclerosis: demographic, clinical, and serological features and survival in 1,012 Italian patients. Medicine (Baltimore) 2002; 81:139–153.Google Scholar
- 9.Scussel-Lonzetti L, Joyal F, Raynauld JP, et al. Predicting mortality in systemic sclerosis: analysis of a cohort of 309 French Canadian patients with emphasis on features at diagnosis as predictive factors for survival. Medicine (Baltimore) 2003; 81:154–167.Google Scholar
- 10.Akesson A, Fior G, Krieg T, van Den Hoogen FHJ, Seibold JR. Assessment of skin, joint, tendon muscle involvement. Clin Exp Rheumatol 2003; 21 (Suppl 29):S5―S8.Google Scholar
- 11.Kahaleh B, Meyer O, Scorza R. Assessment of vascular involvement. Clin Exp Rheumatol 2003; 21(Suppl 29):S9―S14.Google Scholar
- 12.Clements PJ, Becvar R, Drosos AA, Ghattas L, Gabrielli A. Assessment of gastrointestinal involvement. Clin Exp Rheumatol 2003; 21(Suppl 29):S15―S18.Google Scholar
- 13.Matucci Cerinic M, D’Angelo S, Denton C, Vlachoyiannopoulos P, Silver R. Assessment of lung involvement. Clin Exp Rheumatol 2003; 21 (Suppl 29):S19―S23.Google Scholar
- 14.Ferri C, Emdin M, Nielsen H, Bruhlmann P. Assessment of heart involvement: Clin Exp Rheumatol 2003; 21(Suppl 29):S24―S28.Google Scholar
- 15.Steen VD, Mayes MD, Merkel PA. Assessment of kidney involvement. Clin Exp Rheumatol 2003; 21(Suppl 29):S29―S31.Google Scholar
- 16.McHugh NJ, Distler O, Giacomelli R, Riemekasten G. Non organ based laboratory markers in systemic sclerosis. Clin Exp Rheumatol 2003; 21(Suppl 29):S32―S38.Google Scholar
- 17.Valentini G, Silman AJ, Veale D. Assessment of disease activity. Clin Exp Rheumatol 2003; 21(Suppl 29):S39―S41.Google Scholar
- 18.Medsger TA Jr, Bombardieri S, Czirijak I, Scorza R, Della Rossa A, Bencivelli W. Assessment of disease severity and prognosis. Clin Exp Rheumatol 2003; 21(Suppl 29):S42―S46.Google Scholar
- 19.Valentini G, Medsger TA Jr, Silman AJ, Bombardieri S. Conclusion and identification of the core set of variables to be used in clinical investigations. Clin Exp Rheumatol 2003; 21 (Suppl 29):S47–S48.Google Scholar
- 21.Ranza R, Marchesoni A, Calori G, et al. The Italian version of the functional disability index of the health assessment questionnaire. A reliable instrument for multicenter study on rheumatoid arthritis. Clin Exp Rheumatol 1993; 11:123–128.Google Scholar
- 24.Misra R, Darton K, Jewkes RF, Black CM, Maini RN. Arthritis in scleroderma. Br J Rheumatol 1995; 34:831–837.Google Scholar
- 26.Jinnin M, Ihn H, Yamane K, Asano Y, Yazawa N, Tamaki K. Clinical features of patients with systemic sclerosis accompanied by rheumatoid arthritis. Clin Exp Rheumatol 2003; 21:91–94.Google Scholar
- 28.Bloka KLN, Bassett LW, Furst DE, Clements PJ, Paulus H. The arthropathy of advanced progressive systemic sclerosis. A radiographic survey. Arthritis Rheum 1981; 234:874–884.Google Scholar
- 29.Armstrong RD, Gibson T. Scleroderma and erosive polyarthritis: a disease entity ? Ann Rheum Dis 1982; 41:141–146.Google Scholar
- 30.Gladman DD, Rahman P. Psoriatic arthritis. In: Ruddy S, Harris ED, Sledge CB, eds. Kelley’s textbook of rheumatology, 6th edn. Philadelphia: WB Saunders, 2001:1071–1079.Google Scholar
- 35.Peterfy CG. MR imaging. In: Bird HA, Dougados M, eds. Imaging techniques. Part II: Modern methods. Baillieres Clin Rheumatol 1996; 10:645–678.Google Scholar