Die Bedeutung der Röntgendiagnostik der Hände beim Systemischen Lupus erythematodes. Aus einer retrospektiven klinischröntgenologischen Studie von 124 Patienten mit Kollagenosen

Abstract

40 patients with SLE were assessed, the diagnoses being made according to modified ARA-criteria; the hand films of 25 of these patients were analysed. The most important roentgenologic findings consisted of reducible deformities with mild or absent articular changes in the deformed MCP and PIP joints. As these changes often occur late in the course of SLE, a primary radiological diagnosis was possible in only three cases (8%), whereas hand films provided confirmatory evidence of disease in a further seven patients. These roentgenological characteristics of SLE were found significantly less often (p < 0.01) in patients with definite RA (3% compared to 30% of 40 SLE patients); this group tended to have positive ANF (antinuclear factors). Antibodies against DNA may be absent, especially in a less active phase of disease. ANF is non-specific, and SLE simulates RA in 10-20% of cases. It is, therefore, very important in individual cases to consider the diagnosis of SLE in the presence of deformity without corresponding articular changes. Direct comparison of both the p.a. and oblique views is essential in the evaluation of reducible deformities, although this point has not been stressed in the literature. Reducible deformities may be overlooked in physical examination, when the patient gives no history of functional disability. The main differential diagnosis is Jaccoud's arthropathy, which is rarely seen in a general hospital. Most of these patients give a history of recurrent rheumatic fever, a minority complain about joint pain or disability, approximately 90% show signs indicating a valvular lesion of the heart, over 75% have a normal ESR and a positive rheumatoid or antinuclear factor is very rarely found. The distinction from SLE or rheumatoid arthritis is therefore easily established on additional non-radiological criteria.