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.
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Zimmermann C, Steiner G, Skriner K, Hassfeld W, Petera P, Smolen JS (1998) The concurrence of rheumatoid arthritis and limited systemic sclerosis: clinical and serologic characteristics of an overlap syndrome. Arthritis Rheum 41(11):1938–1945
Sandqvist G, Hesselstrand R, Eberhardt K (2009) A longitudinal follow-up of hand involvement and activities of daily living in early systemic sclerosis. Scand J Rheumatol 38(4):304–310
Arslan Tas D (1980) Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23(5):581–590
LeRoy EC, Black C, Fleischmajer R et al (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205
McHugh NJ, Distler O, Giacomelli R, Riemekasten G (2003) Non organ based laboratory markers in systemic sclerosis. Clin Exp Rheumatol 21(3 Suppl 29):S32–S38
Avouac J, Guerini H, Wipff J, Assous N, Chevrot A, Kahan A, Allanore Y (2006) Radiological hand involvement in systemic sclerosis. Ann Rheum Dis 65(8):1088–1092
Akesson A, Fiori G, Krieg T et al (2003) Assessment of skin, joint, tendon and muscle involvement. Clin Exp Rheumatol 29 (Suppl):S5e8
Kahaleh B, Meyer O, Scorza R (2003) Assessment of vascular involvement. Clin Exp Rheumatol 29(Suppl 29):S9e14
Clements PJ, Becvar R, Drosos AA et al (2003) Assessment of gastrointestinal involvement. Clin Exp Rheumatol 29(Suppl):S15e8
Matucci-Cerinic M, D’Angelo S, Denton CP et al (2003) Assessment of lung involvement. Clin Exp Rheumatol 29(Suppl):S19e23
Ferri C, Emdin M, Nielsen H et al (2003) Assessment of heart involvement. Clin Exp Rheumatol 29(Suppl):S24e8
Steen VD, Mayes MD, Merkel PA (2003) Assessment of kidney involvement. Clin Exp Rheumatol 29(Suppl):S29e32
Clements P, Lachenbruch P, Siebold J, White B, Weiner S, Martin R, Weinstein A, Weisman M, Mayes M, Collier D et al (1995) Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol 22(7):1281–1285
Valentini G, Della Rossa A, Bombardieri S et al (2001) European multicentre study to define disease activity criteria for systemic sclerosis. II. Identification of disease activity variables and development of preliminary activity indexes. Ann Rheum Dis 60(6):592–598
Silman A, Akesson A, Newman J et al (1998) Assessment of functional ability in patients with scleroderma: a proposed new disability assessment instrument. J Rheumatol 25:79–83
Blocka KL, Bassett LW, Furst DE, Clements PJ, Paulus HE (1981) The arthropathy of advanced progressive systemic sclerosis A radiographic survey. Arthritis Rheum 24(7):874–884
Misra R, Darton K, Jewkes RF, Black CM, Maini RN (1995) Arthritis in scleroderma. Br J Rheumatol 34(9):831–837
Baron M, Lee P, Keystone EC (1982) The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 41(2):147–152
Erre GL, Marongiu A, Fenu P, Faedda R, Masala A, Sanna M, Soro G, Tocco A, Piu D, Marotto D, Passiu G (2008) The “sclerodermic hand”: a radiological and clinical study. Joint Bone Spine 75(4):426–431
La Montagna G, Sodano A, Capurro V, Malesci D, Valentini G (2005) The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study. Skeletal Radiol 34(1):35–41
Takasaki Y, Yamanaka K, Takasaki C, Matsushita M, Yamada H, Nawata M, Matsudaira R, Ikeda K, Kaneda K, Hashimoto H (2004) Anticyclic citrullinated peptide antibodies in patients with mixed connective tissue disease. Mod Rheumatol 14(5):367–375
van Paassen P, Damoiseaux J, Tervaert JW (2003) Laboratory assessment in musculoskeletal disorders. Best Pract Res Clin Rheumatol 17(3):475–494
Ingegnoli F, Galbiati V, Zeni S, Meani L, Zahalkova L, Lubatti C, Soldi A, Paresce E, Murgo A, Crapanzano C, Fantini F (2007) Use of antibodies recognizing cyclic citrullinated peptide in the differential diagnosis of joint involvement in systemic sclerosis. Clin Rheumatol 26(4):510–514
Clements PJ, Seibold JR, Furst DE, Mayes M, White B, Wigley F, Weisman MD, Barr W, Moreland L, Medsger TA Jr, Steen V, Martin RW, Collier D, Weinstein A, Lally E, Varga J, Weiner SR, Andrews B, Abeles M, Wong WK (2004) High-dose versus low-dose D-penicillamine in early diffuse systemic sclerosis trial: lessons learned. Semin Arthritis Rheum 33(4):249–263
Ashida R, Ihn H, Mimura Y, Jinnin M, Asano Y, Kubo M, Tamaki K (2007) Clinical features of scleroderma patients with contracture of phalanges. Clin Rheumatol 26(8):1275–1277
Ingegnoli F, Boracchi P, Ambrogi F, Gualtierotti R, Galbiati V, Meroni PL (2010) Hand impairment in systemic sclerosis: association of different hand indices with organ involvement. Scand J Rheumatol 39(5):393–397
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Arslan Tas, D., Erken, E., Sakalli, H. et al. Evaluating hand in systemic sclerosis. Rheumatol Int 32, 3581–3586 (2012). https://doi.org/10.1007/s00296-011-2205-3
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DOI: https://doi.org/10.1007/s00296-011-2205-3