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Rheumatology Advance Access originally published online on September 3, 2009
Rheumatology 2009 48(11):1414-1417; doi:10.1093/rheumatology/kep250
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Ultrasonographic features of the hand and wrist in systemic sclerosis

Giovanna Cuomo1, Marcello Zappia1, Giuseppina Abignano1, Michele Iudici1, Antonio Rotondo1 and Gabriele Valentini1

1Department of Internal Medicine, Second University of Naples, Naples, Italy.

Correspondence to: Giovanna Cuomo, Unità di Reumatologia della, Seconda Università di Napoli, Policlinico Via Pansini, 5-80131 Napoli, Italy. E-mail: giovanna.cuomo{at}unina2.it


  Abstract

Objectives. To investigate ultrasonographic hand and wrist features in patients with SSc and their correlation with clinical and X-ray examinations.

Methods. All the patients and controls underwent clinical examination, X-ray and ultrasonography (US) evaluations of the hands and wrists. Forty-five SSc patients all of whom satisfied the ACR criteria and 45 controls—15 patients with RA, 15 patients with FM syndrome and 15 healthy subjects were assessed. US was performed by a General Electric Logiq-5 PRO using a 7-12 MHz linear array transducer.

Results. Joint effusion was found in 22 (49%) SSc patients; synovial proliferation in 19 (42%), which was associated with a power Doppler signal in 11 of them; marginal bone erosions in 5 (11%); joint space narrowing in 8 (18%); periarticular calcinosis in 12 (27%); and osteophytosis in 26 (59%). In SSc patients, the prevalence of synovitis as detected by US (i.e. effusion and/or synovial proliferation) was found to be significantly higher than that found by clinical examination (i.e. tenderness and/or swelling) (26 vs 15 out of 45 cases; P = 0.03). US indicated a significantly higher number of joints with osteophytes than X-rays (59 vs 27%; P < 0.005).

Conclusions. Our study depicts the main sonographic abnormalities of the SSc hand. Using US, we found an unexpectedly high prevalence of joint pathology in SSc without clinically involved hands. The clinical usefulness of US in the assessment of SSc articular involvement either in clinical practice or in therapeutic trials is yet to be defined.

KEY WORDS: Systemic sclerosis, Ultrasonography, Arthropathy, Hand, Wrist, Radiology

Submitted 15 April 2009; revised version accepted 16 July 2009.
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