Evaluating hand in systemic sclerosis

Abstract

Articular symptoms are common in SSc and joint pain is a frequent presenting feature of this disease. Hand involvement is often the first clinical manifestation of SSc and could be resulted from fibrosis or synovitis or an overlap syndrome with rheumatoid arthritis (RA); though, the latter is a controversy in practice. To define the clues when identifying the nature of the hand arthropathy in SSc. In order to determine the hand arthropathy, serological tests, hand radiography, finger-to-palm (FTP) distance and other clinical features, disease activity and functional scoring parameters were assessed. Twenty-eight consecutive SSc patients and 43 controls (21 rheumatoid arthritis and 22 healthy controls) were included. Radiographic findings in SSc patients were: Erosions 25%, joint space narrowing 17.9%, arthritis 10.7%, radiological demineralisation 42.9%, acro-osteolysis 25%, flexion contracture 28.6% and calcinosis 17.9%. Anti-CCP antibody and RF positivity were as follows: In SSc group: 3 (11%) and 7 patients (25%); In RA group: 13 (62%) and 19 patients (90.5%); In healthy control group: 1 (4%) and 3 persons (13.6%), respectively. Two patients (7.14%) were regarded as RA overlap, whom both had positive RF and positive anti-CCP results and their radiographs revealed arthritis. Seventeen patients (61%) were regarded as SSc arthropathy; all were negative for RF and anti-CCP but revealed nonarthritic radiological findings. (Among them, only one patient had positive anti-CCP result). The remainder (9 patients) had no radiological or serological finding positive for arthropathy. Arthritis was found to have correlation with heart involvement and FTP was correlated with lung involvement. Hand involvement in SSc is a challenge in rheumatology practice; Radiographic testing when evaluated with RF and anti-CCP will be a helpful tool to discriminate SSc arthropathy from RA-SSc overlap. Hand arthropathy should increase the interest in the serious internal organ involvements of SSc.

Sacroiliac joint involvement in systemic sclerosis

“…Among the overlap syndromes of SSc, myositis (42.8%), rheumatoid arthritis (32%), Sjögren's syndrome (16.8%) and SLE (8.4%) are the most common . In a previous study conducted by our group, the SSc overlap with rheumatoid arthritis was reported to be 7.1% . Sacroiliitis together with inflammatory back pain is regarded as axial spondyloarthritis according to the ASAS criteria and its frequency was found to be 14% in this study and it means that the frequency of overlap syndrome with axial spondyloarthritis is approximately close to the overlap syndrome with Sjögren's syndrome.…”

In Antisynthetase Syndrome, ACPA Are Associated With Severe and Erosive Arthritis

“…However, despite their high specificity, ACPA may be found in some patients with other systemic autoimmune diseases, including systemic sclerosis 6 – 8 and systemic lupus. 9 – 12 Importantly, in these settings, ACPA positivity has been linked to bone erosions resembling RA.…”

Bilateral coxitis in scleroderma-polymyositis overlap syndrome

“…Radiographic testing, when evaluated with RF and anti-CCP, will be a helpful tool to discriminate SSc arthropathy from RA-SSc overlap (9). In this disorder, the skeletal symptoms are usually symmetrical polyarthralgia and stiffness in the small joints, but the knees, shoulders, and wrists may also be involved (10).…”