Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Ultrasonographic Hand Features in Systemic Sclerosis and Correlates with Clinical, Biological and Radiographic Findings.
Elhai1, Muriel, Guerini2, Henri, Bazeli2, Ramin, Avouac1, Jerome, Freire2, Veronique, Drape3, Jean-Luc, Kahan1, Andre
Rheumatology A, Paris Descartes University, Cochin Hospital, APHP, Paris, France, Paris, France
Radiology B, Paris Descartes University, Cochin Hospital, APHP, Paris, France, Paris, France
Paris Descartes University, Radiology B Department, Cochin Hospital, Paris, France
Articular involvement is a common feature of systemic sclerosis (SSc) with major impact on quality of life. However assessment is frequently difficult, as clinical assessment is limited by concomitant skin involvement and X-ray cannot capture tendon damages. Therefore, the prevalence and characteristics of joint involvement are imperfectly known. Ultrasonography (US) has demonstrated its major input in other rheumatic conditions but only scarce data are available in SSc. Therefore, we set out to investigate ultrasonographic hand and wrists features in consecutive SSc patients and their relationships with clinical examination, biological and radiographic data.
52 consecutive SSc were included in a cross-sectional observational study and in addition 24 patients with rheumatoid arthritis were enrolled as controls. All the patients underwent clinical examination. Global disability was assessed using the Health Assessment Questionnaire and the Duruoz Hand Index. US was performed on joints of both hands, both wrists and fingers. The following predefined features were searched for: synovitis, tenosynovitis, acro-osteolysis, calcinosis, power Doppler in the nail bed and in the pulp. Radiographies of the hands and wrists were also performed. Data were statistically analyzed using chi-square tests and the Student's t-test. A multivariate stepwise logistic regression analysis was also performed for all variables identified with p <= 0.10. P< 0.05 was considered statistically significant.
The characteristics of SSc-patients were: mean age: 56.3 (± 14.1) years, 75% were women, mean disease duration: 8.6 (± 8.6) years, 40% fulfilled diffuse cutaneous subtype. Prevalences of US abnormalities in SSc-patients were as follow: synovitis in 46%, tenosynovitis in 27%, calcifications in 40%, acroosteolysis in 19% and impairment in the distal microvascularisation in 44%. Synovitis were in 57% of cases mildly inflammatory (Doppler grade 1), whereas tenosynovitis showed a mixed pattern associating both inflammatory and fibrotic changes. As compared to RA patients, US hand features specific to SSc were "sclerosing" tenosynovitis (p<0.01), soft-tissue calcifications (p=0.01) and impairment in the distal microvascularisation (p<0.01). US detected 31% and 21% more patients with synovitis and tenosynovitis, respectively, than clinical examination. In multivariate analysis, a CRP level superior to 10mg/L was associated with inflammatory activity at power Doppler assessment (p=0.03). Disability did not correlate with synovitis or tenosynovitis. However, patients with at least 4 synovitis and/or tenosynovitis had a higher Duruoz Hand index than patients with less than 4 US abnormalities (p=0.006).
Our study confirms that articular involvement in SSc is frequent. It is associated with disability in cases of polyarticular disease and under-estimated by clinical examination. It is characterized by mild inflammatory damages associated with biological inflammatory syndrome and with US sclerosing findings for tenosynovitis. Further prospective studies are warranted to evaluate the predictive value of these findings.
To cite this abstract, please use the following information:
Elhai, Muriel, Guerini, Henri, Bazeli, Ramin, Avouac, Jerome, Freire, Veronique, Drape, Jean-Luc, et al; Ultrasonographic Hand Features in Systemic Sclerosis and Correlates with Clinical, Biological and Radiographic Findings. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1718