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The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study

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Abstract

Objective

To assess the clinical and radiological features of systemic sclerosis (SSc) joint involvement in a prospective cross-sectional study.

Design and patients

Seventy-six consecutive patients with SSc divided into clinical and serological subsets were investigated. Clinical and radiological assessments of the hands and feet were carried out. Three radiological patterns of inflammatory, degenerative and fibrotic changes were predefined. The Health Assessment Questionnaire (HAQ) disability index (DI) and individual components of the HAQ-DI were also evaluated.

Results

The highest impairments on the HAQ-DI (median 0.44; range 0–2.87) were detected in subdimensions such as hygiene, grip and activity components. Clinically articular involvement, arthralgia and finger contractures were seen more frequently than arthritis, and a significantly higher prevalence of finger flexion was found in patients with diffuse cutaneous SSc (P=0.03) compared with the other SSc subtypes. Radiologically, distal interphalangeal joint space narrowing and flexion deformity indicating periarticular fibrosis were frequently detected. Juxta-articular osteoporosis, joint space narrowing and flexion contractures of the fingers were seen significantly more frequently in the hands. A significantly higher frequency of fibrotic pattern were found in the hands whereas a degenerative pattern was more frequent in the feet (P<0.05). Finally, significant correlations were detected between flexion contractures and a radiological fibrotic pattern (P<0.001), and the severity scores of peripheral vascular impairment (P=0.026) and skin (P=0.007).

Conclusion

This cross-sectional prospective study confirms that an arthropathy is common in SSc patients and shows that it is a major determinant of disability. A classification of radiological alterations into three specific patterns is proposed.

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Authors and Affiliations

  1. Dipartimento Medico-Chirurgico di Internistica, Clinica e Sperimentale “F Magrassi e A Lanzara”, Unità Operativa di Reumatologia, Seconda Università di Napoli, via S Pansini, 5, 80131, Naples, Italy

    Giovanni La Montagna, Domenico Malesci & Gabriele Valentini

  2. Dipartimento di Diagnostica per Immagini e Radioterapia, Università “Federico II”, via S Pansini, 5, 80131, Naples, Italy

    Antonio Sodano & Vittorio Capurro

Authors
  1. Giovanni La Montagna
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  2. Antonio Sodano
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  3. Vittorio Capurro
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  4. Domenico Malesci
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  5. Gabriele Valentini
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Correspondence to Giovanni La Montagna.

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La Montagna, G., Sodano, A., Capurro, V. et al. The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study. Skeletal Radiol 34, 35–41 (2005). https://doi.org/10.1007/s00256-004-0830-6

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  • DOI: https://doi.org/10.1007/s00256-004-0830-6

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