Musculoskeletal ultrasound on the hand and wrist in systemic Sclerosis

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Abstract

Background

Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disorder. Musculoskeletal involvement represents a major cause of disability in SSc, which is localized especially at the level of the hands and feet. Musculoskeletal ultrasound (MSUS) had become a reference imaging tool in the evaluation of joint and softtissue abnormalities in rheumatic diseases.

Aim of the work

This study aimed to characterize ultrasonographic changes of the hand and wrist in patients with SSc as compared with patients with rheumatoid arthritis (RA), as well as determine the relation of these changes with clinical, laboratory, and radiographic findings in SSc.

Patients and methods

Twenty SSc patients and 20 control RA patients were included in this study. All patients underwent history taking, clinical examination, hand/wrist plain radiography, and MSUS performed on both hand and wrist joints.

Results

MSUS was more sensitive than radiographies in detecting soft-tissue calcifications in SSc patients and also in detecting erosions with no statistically significant difference (P>0.05). In SSc patients, the prevalence of synovitis and tenosynovitis detected by ultrasound was found to be statistically significantly higher than that found by clinical examination (P=0.025 and 0.011, respectively). Patients with higher values of erythrocyte sedimentation rate and C-reactive protein were more likely to have synovitis and/or tenosynovitis and inflammatory activity on power Doppler assessment.

Conclusion

Ultrasound was more accurate than clinical examination and conventional radiography in the detection of subclinical synovitis, tenosynovitis, and the underlying fibrotic changes of tendon friction rub. In SSc patients, on using MSUS, articular involvement was found to be less frequent compared with that in RA patients, with specific appearance of sclerosing tenosynovitis in SSc patients.

References

  1. 1

    Castro SV, Jimenej SA. Biomarkers in systemic sclerosis. Biomark Med 2010; 41:33–147.

    Google Scholar 

  2. 2

    Joshua F. Ultrasound applications for the practicing rheumatologist. Best Pract Res Clin Rheumatol 2012; 26:853–867.

    PubMed  Article  Google Scholar 

  3. 3

    Robinson P. Sonography of common tendon injuries. Am J Rev 2009; 193:607–618.

    Google Scholar 

  4. 4

    Rubin JM, Bude RO, Carson PL, Bree RL, Adler RS. Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. Radiology 1994; 190:853–856.

    CAS  PubMed  Article  Google Scholar 

  5. 5

    Colquhoun K, Alam A, Wilson D. Basic science: ultrasound. Curr Orthop 2005; 19:27–33.

    Article  Google Scholar 

  6. 6

    Leroy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988; 15:202–205.

    CAS  PubMed  Google Scholar 

  7. 7

    Ahmed R, Nazarian L. Overview of musculoskeletal sonography. Ultrasound Q 2010; 26:27–35.

    PubMed  Article  Google Scholar 

  8. 8

    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, BinghamCOIII, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative study. Ann Rheum Dis 2010; 69:1580–1588.

    PubMed  Article  Google Scholar 

  9. 9

    Clements PJ, Lachenburck PA. Seibold JR. Inter- and intra-observer variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol 1995; 22:1281.

    CAS  PubMed  Google Scholar 

  10. 10

    Cammarota T, Pinto F, Magliaro A, Sarno A. Current uses of diagnostic highfrequency US in dermatology. Eur J Radiol 2008; 27:215–219.

    Article  Google Scholar 

  11. 11

    Akesson A, Hesselstrand R, Scheja A, et al. Longitudinal development of skin involvement and reliability of high frequency ultrasound in systemic sclerosis. Ann Rheum Dis 2004; 63:791–794.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. 12

    Astbury C, Platt R, Dixon J, et al. Optimizing the assessment of disease activity during treatment with anti-rheumatoid drugs. Brit J Rheumatol 2001;32:467–468.

    Article  Google Scholar 

  13. 13

    Boutry N, Morel M, Flipo R, et al. Early rheumatoid arthritis: a review of MRI and sonographic findings. Am J Roentgenol 2007; 189:1502–1509.

    Article  Google Scholar 

  14. 14

    Montagna G, Sodano A, Capurro V, et al. The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study. Skeletal Radiol 2005; 34:35–41.

    PubMed  Article  Google Scholar 

  15. 15

    Weidekamm C, Koller M, Weber M, et al. Diagnostic value of highresolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003; 48:325–333.

    CAS  PubMed  Article  Google Scholar 

  16. 16

    Elhai M, Guerini H, Bazeli R, et al. Ultrasonographic hand features in systemic sclerosis and correlates with clinical, biologic, and radiographic findings. Arthritis Care Res 2012; 64:1244–1249.

    Google Scholar 

  17. 17

    Gohar N, Ezzyat Y, Naeem N, et al. A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: relation to disease activity, clinical and radiological findings. Egypt Soc Rheumatic Dis 2015; 37:177–184.

    Article  Google Scholar 

  18. 18

    Cuomo G, Zappia M, Abignano G, Iudici G, Rotondo A. Ultrasonographic features of the hand and wrist in systemic sclerosis. Rheumatology 2009; 48:1414–1417.

    PubMed  Article  Google Scholar 

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Correspondence to Rasha M. Fawzy MD.

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Fawzy, R.M. Musculoskeletal ultrasound on the hand and wrist in systemic Sclerosis. Egypt Rheumatol Rehabil 43, 95–101 (2016). https://doi.org/10.4103/1110-161X.189825

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Keywords

  • rheumatoid arthritis
  • systemic sclerosis
  • ultrasound