Abstract
Musculoskeletal involvement is one of the major causes of impairment in daily life of patients with systemic sclerosis (SSc). Several hand radiographic findings can be seen in SSc patients; however, their association with clinical features and autoantibodies remains unclear. Here, we analyzed 124 SSc patients with their hand X-rays and clinical and serological features. Abnormal findings in hand X-rays including acro-osteolysis, calcinosis, flexion contracture, erosive change, joint space narrowing, and subluxation were observed in 110 patients (68%). These X-ray findings were more prevalent in patients with longer disease duration and digital ischemic changes. The majority of erosions were typical for erosive hand osteoarthritis, which was seen in 19% of patients. Hand X-ray findings were associated with involved organs; acro-osteolysis with interstitial lung disease, calcinosis with pulmonary arterial hypertension and gastrointestinal tract involvement, and flexion contracture with gastrointestinal tract involvement. Those findings were also relevant to autoantibodies; acro-osteolysis was more common in SSc patients with anti-Scl70 antibody but less in patients with anticentromere antibody. Calcinosis was more prevalent in patient with anticentromere antibody. In our study, organ involvements and SSc-associated autoantibodies showed associations with hand radiographic abnormalities. Hand X-ray findings might reflect underlying pathogenesis and autoantibody profiles in SSc patients.
Key Points • Hand X-ray abnormalities were observed in approximately two-thirds of patients with SSc. • Erosive osteoarthritis was more prevalent in SSc patients than general population. • Hand X-ray findings were associated with disease duration, organ involvements, and SSc-associated autoantibodies, reflecting underlying pathogenesis. |
References
Avouac J, Walker U, Tyndall A, Kahan A, Matucci-Cerinic M, Furst DE et al (2010) Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database. J Rheumatol 37:1488–1501
Baron M, Lee P, Keystone EC (1982) The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 41:147–152
Sandqvist G, Eklund M, Akesson A, Nordenskiöld U (2004) Daily activities and hand function in woman with scleroderma. Scand J Rheumatol 33:102–107
Koutaissoff S, Vanthuyne M, Smith V, De Langhe E, Depresseux G, Houssiau FA et al (2011) Hand radiological damage in systemic sclerosis: comparison with a control group and clinical and functional correlations. Semin Arthritis Rheum 40:455–460
Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnosic and Therapeutic Criteria Committee. (1980) Arthritis Rheum 23: 581–90
LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Wollheim F et al (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205
Avouac J, Guerini H, Wipff J, Assous N, Chevrot A, Allanore Y et al (2006) Radiological hand involvement in systemic sclerosis. Ann Rheum Dis 65:1088–1092
Punzi L, Ramonda R, Sfriso P et al (2004) Erosive osteoarthritis. Best Pract Res Clin Rheumatol 18:739–758
La Montagna G, Sodano A, Capurro V, Malesci D, Valentini G (2005) The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study. Skelet Radiol 34:35–41
Kodama R, Muraki S, Oka H, Iidaka T, Teraguchi M, Yoshimura N et al (2016) Prevalence of hand osteoarthritis and its relationship to hand pain and grip strength in Japan: the third survey of the ROAD study. Mod Rheumatol 26:767–773
Kwok WY, Kloppenburg M, Rosendaal FR, van Meurs JB, Hofman A, Bierma-Zeinstra SM (2011) Erosive hand osteoarthritis: its prevalence and clinical impact in the general population and symptomatic hand osteoarthritis. Ann Rheum Dis 70:1238–1242
Emma M, Hutchinson CE, Vali A, Chevance A, Herrick AL (2012) Acro-osteolysis in systemic sclerosis is associated with digital ischaemia and severe calcinosis. Rheumatology 51:2234–2238
Avouac J, Mogavero G, Guerini H, Drapé JL, Mathieu A, Allanore Y et al (2011) Predictive factors of hand radiographic lesions in systemic sclerosis: a prospective study. Ann Rheum Dis 70:630–633
Valenzuela A, Baron M, Canadian Scleroderma Research Group, Herrick AL, Proudman S, Chung L et al (2016) Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: a Scleroderma Clinical Trials Consortium study. Semin Arthritis Rheum 46:344–349
Foocharoen C, Watcharenwong P, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R (2017) Relevance of clinical and autoantibody profiles in systemic sclerosis among Thais. Int J Rheum Dis 20:1572–1581
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the ethics committee of Keio University School of Medicine (approval number: 20130506). The requirement for informed consent from the patients was waived according to the regulation in Japan.
Disclosures
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Supplementary Figure 1.
Representative hand radiographic findings in patients with systemic sclerosis: (A) acro-osteolysis, (B) calcinosis, (C) flexion contracture, (D) erosive changes with marginal erosion, (E) seagull-wing, (F) saw-tooth deformities, (G) joint space narrowing, (H) subluxation. (PNG 1330 kb)
Rights and permissions
About this article
Cite this article
Sakata, K., Kaneko, Y., Yasuoka, H. et al. Association of radiographic findings in hand X-ray with clinical features and autoantibodies in patients with systemic sclerosis. Clin Rheumatol 39, 113–118 (2020). https://doi.org/10.1007/s10067-019-04639-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-019-04639-6