Abstract
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. 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. 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. 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. 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.
Highlights
Systemic sclerosis (SSc) is an autoimmune inflammatory disorder of unknown etiology, characterized by pronounced fibroproliferative alterations in the microvasculature and frequent cellular and humoral abnormalities, resulting in a severe and progressive fibrotic process [1].Scleroderma is a rare disorder but its symptoms occur frequently in the general population, such as Raynaud’s phenomenon, gastroesophageal reflux, fatigue, and joint symptoms, which are reported by 24–97% of SSc patients during the course of their disease
The results of Gohar et al.[17] regarding radiographic features of hand involvement in SSc patients were in agreement with our results, whereas the results reported by Cuomo et al.[18] and Elhai et al.[16] were different
As regards tenosynovitis by Musculoskeletal ultrasound (MSUS) we found that SSc patients had a higher incidence of tenosynovitis compared with rheumatoid arthritis (RA) patients with the sclerosing pattern being specific for SSc and not for RA, whereas inflammatory tenosynovitis occurred in both groups
Summary
Scleroderma is a rare disorder but its symptoms occur frequently in the general population, such as Raynaud’s phenomenon, gastroesophageal reflux, fatigue, and joint symptoms, which are reported by 24–97% of SSc patients during the course of their disease. These symptoms are frequently disabling and can range from mild arthralgia to frank erosive arthritis with synovitis resembling rheumatoid arthritis (RA), contractures, and tendon friction rubs. Musculoskeletal ultrasound (MSUS) had become a reference imaging tool in the evaluation of joint and softtissue abnormalities in rheumatic diseases. 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
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