Abstract
IntroductionThe aim of the present study was to assess the prevalence and characteristics of subclinical arthritis of carpal and metacarpophalangeal joints in patients with systemic sclerosis (SSc).MethodsLow-field (0.2 T) magnetic resonance imaging (MRI) was performed in consecutive patients with SSc attending our center between January 2010 and March 2011. Results were assessed in a standardized manner using the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) and standardized assessments of all hand joints. Patients with arthritis due to overlap syndromes were excluded.ResultsOf 38 inpatients and eight outpatients who were screened for inclusion, 30 patients participated in the study and 26 patients could be evaluated. Erosions, bone marrow edema, synovitis, and joint effusions were found in 87%, 37%, 68%, and 58%, respectively, and 24% of patients had additional tenovaginitis. Arthritis affected only a low number of joints per analyzed hand. All bones and joints could be affected, but synovitis and bone marrow edema occurred predominantly in the proximal row of carpal bones, most frequently affecting the lunate bone. The extent of inflammatory changes measured with the RAMRIS correlated significantly with the functional status assessed with the validated German functional score questionnaire Funktionsfragebogen Hannover.ConclusionLow-grade arthritic changes on low-field MRI are frequent in patients with pure SSc. The features of arthritis in SSc differ from rheumatoid arthritis. The distribution, the MRI pattern and the predilection for the lunate bone raise the hypothesis that arthritis in SSc may be caused not only by immunological inflammation but also by ischemic mechanisms.
Highlights
The aim of the present study was to assess the prevalence and characteristics of subclinical arthritis of carpal and metacarpophalangeal joints in patients with systemic sclerosis (SSc)
While arthritis has been observed in SSc [1], it is frequently considered to indicate an overlap between rheumatoid arthritis (RA) and SSc [2,3], whereas joint pain in patients with sole SSc is commonly regarded as non-inflammatory arthralgia caused by skin tightness and flexion contractures [4]
Four patients were excluded due to overlap with other rheumatic diseases, and three patients were excluded because their clinical condition did not permit magnetic resonance imaging (MRI) measurements
Summary
The aim of the present study was to assess the prevalence and characteristics of subclinical arthritis of carpal and metacarpophalangeal joints in patients with systemic sclerosis (SSc). In the clinical evaluation of systemic sclerosis (SSc), attention is predominantly given to changes of the skin, Raynaud’s phenomenon and its complications, and internal organ involvement. We performed a prospective magnetic resonance imaging (MRI) study of the hands in patients with SSc, excluding patients with clinical or immunological signs suggesting an overlap with other forms of arthritis. We aimed to determine the prevalence of MRI signs of arthritis including synovitis, bone marrow edema, effusions, and erosions as well as to characterize the distribution of joint involvement. MRI was chosen because it is an imaging tool with high sensitivity for the detection of inflammatory joint changes, as has been demonstrated very well in RA [8] and in SSc [9,10]
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