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S.7.1 Ultrasonographic hand features in systemic sclerosis and correlates with clinical, biological and radiographic findings

2012; Oxford University Press; Volume: 51; Issue: suppl 2 Linguagem: Inglês

10.1093/rheumatology/ker501

1462-0332

Muriel Elhaï, H. Guérini, R. Bazeli, Jérôme Avouac, Véronique Freire, Jean‐Luc Drapé, Alan S. Kahan, Yannick Allanore, Giuseppina Abignano, Giovanna Cuomo, Maya H Buch, William Rosenberg, Gabriele Valentini, P. Emery, Francesco Del Galdo, Peter Martin, Walcy Rosólia Teodoro, Ana Paula Pereira Velosa, Solange Carrasco, Jymenez de Morais, Romy Christmann, E. R. Parras, Vera Luíza Capelozzi, Natalino H. Yoshinari, Giovanna Cuomo, Marcello Zappia, Michele Iudici, G. Abignao, Gabriele Valentini,

Medical Imaging and Pathology Studies

Background. Articular involvement is a common feature of 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 wrist features in consecutive SSc patients and their relationships with clinical examination, biological and radiographic data. Materials and methods. A total of 52 consecutive SSc were included in a cross-sectional observational study and in addition 24 patients with RA were enrolled as controls. All the patients underwent clinical examination. Global disability was assessed using the HAQ 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 analysed using chi-square tests and the Student's t-test. A multivariate, step-wise logistic regression analysis was also performed for all variables identified with P < 0.10. P < 0.05 was considered statistically significant. Results. 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 follows: synovitis in 46%, tenosynovitis in 27%, calcifications in 40%, acro-osteolysis in 19% and impairment in the distal microvascularization 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 with 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 microvascularization (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 10 mg/l was associated with inflammatory activity at power Doppler assessment (P = 0.03). Conclusion. Our study confirms that articular involvement in SSc is frequent 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.