Selective involvement of the first carpometacarpal joint in scleroderma

Resnick, Donald; Greenway, Guerdon; Vint, V; Robinson, Cal; Piper, Samantha L.

doi:10.2214/ajr.131.2.283

Cited by 34 publications

(4 citation statements)

References 12 publications

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“…Resnick et al have described bilateral resorption of the trapezium and adjacent metacarpal bone along with intraarticular calcification and erosions, and postulate that the frequently associated muscle atrophy and skin tightening may give rise to a chronic muscle tendon imbalance with secondary osseous resorptive change [18]. Such a carpal lesion characteristic of a destructive arthropathy which is relatively advanced is noted in Case 2 of our report.…”

Section: Discussionsupporting

confidence: 59%

Arthropathy in Patients with CREST Variant Scleroderma

Restrepo

Rondón

Matteson³

et al. 2006

CRR

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Background: Systemic sclerosis is a disease characterized by sclerosis of the skin, internal organs and vasculopathy. Articular manifestations are common, and include arthralgias, arthritis, and morning stiffness, which in some cases can be confused with rheumatoid arthritis (RA). Patients develop functional impairment and thickening of the skin including around the joints, with inflammation and fibrosis of tendon sheaths. However, articular inflammation is rare clinically, as is the development of articular erosions.Objective: To define the presence and characteristics of arthropathy in patients with scleroderma and distinguish it from RA.Methods: Case series of 106 Colombian patients with scleroderma evaluated between January 1998 and December 2004, of whom 5 had significant articular involvement and are the subject of this report.Results: All patients had the CREST variant of scleroderma. Their average age was 48.6 years (range 35-56). All had arthropathy affecting mainly the hands and feet. In the majority of cases the clinical picture resembled that of RA, with inflammation and subluxation of the metacarpophalangeal joints, and involvement of the feet with subluxation of the toes. Radiographs revealed joint space narrowing, subluxation, juxtaarticular osteopenia, carpal ankylosis and erosions. Rheumatoid factor was negative and antinuclear antibody (ANA) was positive with anticentromere antibodies in all patients. Conclusions:We conclude that there is a unique arthropathy of scleroderma which is due to inflammation and mechanical factors related to skin and periarticular involvement from the underlying disease. It is not due to coexisting RA. All of our cases had CREST variant scleroderma with erosive arthritis, negative rheumatoid factor, and positive ANA with centromere antibody. None fulfilled classification criteria for RA. This is a distinct subtype of scleroderma. Patients should be identified and treated promptly to avoid development of serious articular disease. The tendency to develop severe articular disease is likely immunogenetically linked.

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Section: Discussionsupporting

confidence: 59%

Arthropathy in Patients with CREST Variant Scleroderma

Restrepo

Rondón

Matteson³

et al. 2006

CRR

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“…Joint space narrowing affecting primarily the MCP and radiocarpal joints was the most frequently identified abnormality.$ RA-like marginal erosions involving the volar aspect of the MCP joints or the ulnar styloid were observed in 9% of the patients (Figure 1). We found no instances of erosions involving distal interphalangeal joints (3 I), nor did we note a predilection for the first carpometacarpal phalangeal joint (32). Isolated advanced erosive changes affecting a single joint as reported by Wild (33) were noted in the proximal interphalangeal (PIP) joint of one patient and the metatarsophalangeal (MTP) joint of another ( Figure 2).…”

Section: Resultsmentioning

confidence: 57%

The arthropathy of advanced progressive systemic sclerosis

Blocka

Bassett

Fürst

et al. 1981

Arthritis & Rheumatism

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The peripheral joint radiographs of 55 carefully selected patients with classic progressive systemic sclerosis (PSS) and 10 patients with CREST syndrome were reviewed in a longitudinal fashion. Thirty-three PSS and 7 CREST patients were available for followup (mean followup period 28.7 and 29.8 months, respectively). The high frequency of conventionally recognized abnormalities such as flexion contractures, digital tuft resorption, sclerodactyly, and subcutaneous calcinosis was reconfirmed. Additional hand findings included joint space narrowing (13%), juxtaarticular demineralization (4%), ankylosis (2%), marginal erosions (%), and previously undescribed dorsal erosions (15%). All PSS findings showed progression, although isolated reversibility was noted. The CREST group showed a similar frequency and distribution of findings but with less tendency to progression. With the exception of an increased active joint count in PSS patients with erosions, computer-assisted analysis of multiple clinical and l a b -

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“…However, the DIP lesions appear to be both deeper and more destructive than the usual picture of erosive osteoarthritis. Selective erosions of the first carpo-metacarpal joint has been described in scleroderma [ 9 , 18 ]. In this study, the PIP joint and radio-carpal joint were the most common site for erosions.…”

Section: Discussionmentioning

confidence: 99%