Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Predictive Factors of Hand Radiographic Lesions in Systemic Sclerosis: A Prospective Study.

Avouac4,  Jerome, Mogavero1,  Giulia, Guerini2,  Henri, Drape2,  Jean-Luc, Mathieu1,  Alessandro, Kahan3,  Andre, Allanore3,  Yannick

2nd Chair of Rheumatology, University of Cagliari, Cagliari, Italy
Paris Descartes University, Radiology B Department, Cochin Hospital, APHP, Paris, France
Paris Descartes University, Rheumatology A Department, Cochin Hospital, APHP, Paris, France
Paris Descartes University, Rheumatology A Department, Cochin Hospital, APHP, Paris, France

Background:

Joint, bone and soft tissue involvement has been shown to strongly contribute to impaired hand function in systemic sclerosis (SSc). We previously showed in a cross-sectional study performed on 120 SSc patients the prominent level of hand radiographic involvement in SSc (1). However, this study had no longitudinal follow-up, precluding the identification of predictors of hand radiographic progression in SSc.

Objective:

To examine the outcomes of hand radiographic X-Rays in patients with SSc and identify risk factors for the progression of hand radiographic lesions in a prospective cohort.

Patients and Methods:

Subsequently to our initial cross-sectional study, dual time-point X-Rays with standard posteroanterior views of the hands and wrists were systematically performed after a median interval of 5 years (range: 4–7 years) in 103 SSc patients consecutively recruited. Univariate and multivariate Cox proportional hazards models evaluated predictors of progression of hand radiographic lesions (incident or worsened involvements) for three radiographic patterns of abnormalities of joints (erosive arthritis, defined by the presence of both erosion and joint space narrowing), bone (acro-osteolysis) and soft tissue (calcifications, flexion contracture). SSc patients (81% women) were 61±12 years old and had mean disease duration of 12±8 years.

Results:

Incidences of erosive arthritis, acro-osteolysis, calcinosis and flexion contracture were 10%, 9% 14% and 8% respectively. The worsening of already known erosive arthritis, acro-osteolysis, calcinosis and flexion contracture occurred respectively in 13.5%, 12.5%, 11.5% and 10% of SSc patients. Cox regression analysis did not identify any predictor of the progression of erosive arthritis. Digital ulcers were shown to independently predict the progression of acro-osteolysis and calcinosis (Hazard Ratio, HR:12.43, 95% confidence interval, CI:1.97–88.40 and HR:3.16, 95%CI:1.22–9.43, respectively). The diffuse cutaneous subset was shown to be an independent predictor of the progression of flexion contracture (HR:7.52, 95%CI:1.21–43.93).

Conclusion:

This is the first prospective study to determine the outcomes and identify predictors of hand radiographic lesions in patients with SSc. This systematic examination highlights the striking level of incident and worsened hand radiographic lesions in SSc after a median interval of 5 years. Our data suggest a close monitoring of patients with the diffuse cutaneous subset with the need of early therapeutic intervention for prevention flexion contracture. Our results also show that severe peripheral vascular involvement predict both acro-osteolysis and calcinosis, highlighting their vascular background and suggesting that the impact of vascular treatments on these severe complications need to be addressed.

(1)Avouac, J et al., Ann Rheum Dis 2006

To cite this abstract, please use the following information:
Avouac, Jerome, Mogavero, Giulia, Guerini, Henri, Drape, Jean-Luc, Mathieu, Alessandro, Kahan, Andre, et al; Predictive Factors of Hand Radiographic Lesions in Systemic Sclerosis: A Prospective Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :728
DOI: 10.1002/art.28496

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