Egyptian Rheumatology and Rehabilitation (Jan 2016)
Musculoskeletal ultrasound on the hand and wrist in systemic sclerosis
Abstract
Background Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disorder. Musculoskeletal involvement represents a major cause of disability in SSc, which is localized especially at the level of the hands and feet. Musculoskeletal ultrasound (MSUS) had become a reference imaging tool in the evaluation of joint and soft-tissue abnormalities in rheumatic diseases. Aim of the work This study aimed to characterize ultrasonographic changes of the hand and wrist in patients with SSc as compared with patients with rheumatoid arthritis (RA), as well as determine the relation of these changes with clinical, laboratory, and radiographic findings in SSc. Patients and methods Twenty SSc patients and 20 control RA patients were included in this study. All patients underwent history taking, clinical examination, hand/wrist plain radiography, and MSUS performed on both hand and wrist joints. Results MSUS was more sensitive than radiographies in detecting soft-tissue calcifications in SSc patients and also in detecting erosions with no statistically significant difference (P > 0.05). In SSc patients, the prevalence of synovitis and tenosynovitis detected by ultrasound was found to be statistically significantly higher than that found by clinical examination (P = 0.025 and 0.011, respectively). Patients with higher values of erythrocyte sedimentation rate and C-reactive protein were more likely to have synovitis and/or tenosynovitis and inflammatory activity on power Doppler assessment. Conclusion Ultrasound was more accurate than clinical examination and conventional radiography in the detection of subclinical synovitis, tenosynovitis, and the underlying fibrotic changes of tendon friction rub. In SSc patients, on using MSUS, articular involvement was found to be less frequent compared with that in RA patients, with specific appearance of sclerosing tenosynovitis in SSc patients.
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