Arthritis in Scleroderma

Abstract

Thirty-four patients (24 females and 10 males) selected from 300 consecutive patients with established systemic sclerosis (SSc), with a current or past history of articular symptoms, were clinically documented and further studied using thermography and bone scan to define the pattern of arthritis. Clinical evidence of synovitis was observed in 30 (88%) and joint inflammation was detected in 31 (91%) by the above-mentioned imaging techniques. A distinctive subset of 10 patients with deforming arthritis was characterized in which seven (70%) patients fulfilled criteria for both rheumatoid arthritis and SSC; three of these satisfied the criteria for diagnosis of CREST, but none met the criteria of mixed connective tissue disease. These patients, as a group, when compared with the rest showed limited skin involvement (skin score of 19 +/- 11 vs 33 +/- 14; P < 0.05) and were positive for rheumatoid factor (80 vs 13%; P < 0.05) and anticentromere antibodies (37 vs 4%; P < 0.05).

Utilização da imagem infravermelha em reumatologia

“…Conjuntamente com a cintilografia ela demonstrou a presença de artrite em 91% e sinovite em 88% de 34 pacientes com esclerose sistêmica (17) .…”

“…É um método inócuo, não-invasivo, não-ionizante, sem contraste, capaz de mensurar a temperatura cutânea a distância com altíssima precisão em forma de imagens de alta resolução. Essa técnica, além de digitalizar as imagens, quantifica a informação em tempo real, distinguindo diferenças de temperatura menores do que 0,07ºC em menos de 0,03 segundo (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) . Recentemente, distintos métodos de imageamento infravermelho foram descritos além do estático: dinâmico com ou sem subtração de imagem, multiespectral e hiperespectral, mapeamento de textura térmica, multimodal, fusão de sensores, fusão com imagens de ressonância magnética (MRIF) e imageamento infravermelho tridimensional com e sem MRIF (21) .…”

Overlap between systemic sclerosis and rheumatoid arthritis: a distinct clinical entity?

“…5 The main ME symptoms shown are movement limitations, joint pain and/or swelling. 6 Arthritis, clinically observed, may be a feature in the initial presentation of SSc, often leading to initial diagnostic errors with rheumatoid arthritis (RA). 7,8 In a series of cases described by Rodnan Medsger, Jr., in 41% of patients, arthritis or polyarthralgia was the first symptom, or developed within the first year after the onset of Raynaud's phenomenon.…”

“…8 In the course of the disease, arthritis is observed in 24-97% of patients with SSc. 6 Joint lesions, ranging from periarticular osteopenia and joint space narrowing to apparent erosions, have been reported in the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints, as well as in the wrists. 5,6 According to Rodnan, the most common radiological abnormality seen in the bones and joints of patients with SSc was the resorption of the terminal phalanges (acroosteolysis), which was often followed by subcutaneous calcinosis.…”

Anti-cyclic citrullinated peptide antibodies in scleroderma patients

“…Musculoskeletal involvement is seen in 24-97% of the patients [1,2] and may present with arthritis, arthralgias, joint contractures, tenosynovitis, muscle atrophy and loss of joint function [3]. A symmetrical polyarthritis similar to rheumatoid arthritis (RA) can also be found characterizing an SSc-RA overlap syndrome [4].…”