Arthritis in Systemic Sclerosis

Abstract

Inflammatory arthritis in systemic sclerosis (scleroderma) is common affecting at least 1 in 6 patients. It is heterogeneous and may mimic rheumatoid arthritis or have ankylosing or severe deformities or overlap with systemic lupus erythematosus. There are many other reasons for joint pain in scleroderma that are not from the disease (such as osteoarthritis, crystal arthritis, tendonitis) or are other manifestations of musculoskeletal problems without inflammatory arthritis (such as tendon friction rubs, hand contractures, calcinosis, tuft resorption). The diagnosis of inflammatory arthritis in scleroderma often requires a history, physical examination demonstrating joint swelling, lab tests to determine if there is seropositivity (such as rheumatoid factor) and hand radiographs. The treatment is dependent on the severity and type of inflammatory arthritis and is often borrowed from rheumatoid arthritis treatment with use of methotrexate, antimalarials, low dose glucocorticoids and possibly biologics as warranted. There are likely emerging therapies that will help inflammatory arthritis that need to be tested in scleroderma using validated outcome measurements. Research is needed to phenotype patients with scleroderma and arthritis accurately with respect to the type of arthritis and potential prognosis and response to treatment.