Abstract
The aim of the study was the detection of inflammatory arthropathy in patients with systemic sclerosis (SSc) with arthralgia using musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) and to compare between MRI versus MSUS detecting musculoskeletal abnormalities and find out its relation with other clinical and laboratory parameters. Sixteen SSc patients with hand arthralgia had a baseline MSUS for their hands. Six months later, patients had a second MSUS and MRI with gadolinium of their most symptomatic hand. Of the 16 patients examined by MSUS, it was found that on baseline and second examination, tenosynovitis was seen in 8 (50 %) and 7 (43.7 %) patients and synovitis was seen in 4 (25 %) and 5 (31 %) patients, respectively, indicating persistence synovial inflammation, and erosion was seen in only 1 (6.3 %) patient on baseline and second examination. Regarding MRI, 81.3 % (13) patients had tenosynovitis, 87.5 % (14) patients had synovitis, and 62.5 % (10) patients had erosions. Applying the RAMRIS system (a semiquantitative MRI scoring system used in RA), the mean values for synovitis, bone marrow edema, and erosions fell within the range seen in RA. Systemic sclerosis patients with arthralgia that have no obvious clinical inflammatory arthritis were found to have persistent inflammatory erosive arthropathy in their hands and wrists using MSUS and MRI. While both MRI and MSUS are useful in characterizing synovial inflammation in SSc, MRI is clearly more sensitive than MSUS in this setting. Further studies on larger number of SSc patients with arthralgia and a control group consisting of SSc patients without arthralgia to better establish the clinical and radiological findings in SSc.
Highlights
Systemic sclerosis (SSc; scleroderma) is a chronic disorder of connective tissue characterized by inflammation, fibrosis, and degenerative changes in the blood vessels, skin, synovium, skeletal muscle, and multiple internal organs
Of the 16 patients examined by musculoskeletal ultrasonography (MSUS), it was found that on baseline and second examination, tenosynovitis was seen in 8 (50 %) and 7 (43.7 %) patients and synovitis was seen in 4 (25 %) and 5 (31 %) patients, respectively, indicating persistence synovial inflammation, and erosion was seen in only 1 (6.3 %) patient on baseline and second examination
Applying the RAMRIS system, the mean values for synovitis, bone marrow edema, and erosions fell within the range seen in RA
Summary
Systemic sclerosis (SSc; scleroderma) is a chronic disorder of connective tissue characterized by inflammation, fibrosis, and degenerative changes in the blood vessels, skin, synovium, skeletal muscle, and multiple internal organs. The clinical features, organ system involvement, natural history, and survival among patients with SSc are highly variable and largely depend on SSc clinical subtype and SSc-associated serum autoantibodies [1]. The musculoskeletal findings in progressive systemic sclerosis have been the subject of continued controversy, partly because most reports describe mixed populations of SSc, mixed connective tissue disease (MCTD), overlap syndromes of several connective tissue diseases and calcinosis, Rheumatol Int (2013) 33:1961–1966. Generalized arthralgia and morning stiffness are typical symptoms of systemic sclerosis and may be confused with early RA [3]. Inflammatory and fibrinous involvement of tendon sheaths may mimic arthritis [3]
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