The significance of terminal phalangeal osteosclerosis.

Abstract

Osteosclerosis of the terminal phalanges of the hand has been reported in scleroderma (1) and as a benign clinical entity usually found in females over the age of forty (7). Observation of this roentgenographic sign in a patient with systemic lupus erythematosus led to the following study. Methods and Materials Hand films of patients in the following categories and their respective numbers were evaluated: 200 consecutive cases of acute trauma; 100 consecutive cases of rheumatoid arthritis; 100 consecutive cases of osteoarthritis; 24 cases of systemic lupus erythematosus; 3 cases of dermatomyo-sitis; 2 cases of periarteritis nodosa. These last 3 groups comprise the last five years experience at the University of Colorado Medical Center. Twenty cases of gout (the last three years experience) were also examined. The roentgenographic changes were divided into two main categories: Isolated terminal spongiosclerosis and diffuse spongiosclerosis combined with endosteal sclerosis. Results The results of the major series can be seen in Table I. Rheumatoid arthritis: Thirty-five cases (35 per cent) were interpreted as positive. Twenty-seven of these patients showed condensation of bone confined to the spongiosa of the terminal digits (Fig. 1), and 8 revealed the diffuse type of sclerosis of one or more digits (Fig. 2). The sclerosis in the spongiosa varied from a single, dense fleck in one digit to involvement of all the digits. Approximately one-third of the patients in each age group showed some form of sclerosis. Systemic lupus erythematosus: Of the 24 cases, 15 were negative and 9 (37 per cent) were positive (Fig. 3). These were almost evenly divided as to the type of sclerosis. Osteoarthritis: The 6 positive cases (6 per cent) were all seen in patients over the age of sixty, and in all only a single digit was involved. These showed only a small fleck of condensation in the terminal spongiosa. Trauma: The 3 cases (1.5 per cent) which demonstrated sclerosis were found between the ages of thirty and forty-nine, and, again, only a small fleck of spongiosclerosis was present. This study was skewed toward the younger age group and Only 2 periarteritis patients with hand films were evaluated, 1 being negative, the other strikingly positive (Fig. 4). The terminal osteosclerosis is present despite evidence of osteoporosis in other areas of the hand. The 3 cases of dermatomyositis showed osteoporosis and contracture but no osteosclerosis. All were in patients under the age of ten. Discussion Edeiken in 1929 described 3 cases of scleroderma with sclerodactylia. All showed absorption of the terminal tufts, and one exhibited punctate calcification in the terminal phalangeal spongiosa (1). These same roentgenographic changes have since been described by others (4, 5).