Radiologic hand and wrist changes in systemic sclerosis: Associations with the disease duration, skin score and capillaroscopy

Patients with systemic sclerosis (SSc) have some musculoskeletal manifestations. The radiologic manifestations can be articular or non-articular. There is inconsistency in the correlation between clinical manifestations and radiologic changes; there are few reports on the correlation between them and capillaroscopy. We evaluated 81 patients with SSc, using a cross- sectional single center study, referred to scleroderma clinic affiliated to Shiraz University of Medical Sciences, Iran. Skin score and capillaroscopy were performed and an expert radiologist did the radiologic evaluation of the posterior-anterior views of both hands and wrists. For data analysis, SPSS version 19 was used. The participants consisted of 73 women and eight men aged 42±2.6 years old. There were 60.5% limited scleroderma (lcSSc) and 39.5% diffuse scleroderma (dcSSc) patients. After 5 years, 91% of them had some radiologic changes mostly asymptomatic.The most common radiologic changes were non-articular (70.1%), including acro-osteolysis, subcutaneous and peri-articular calcinosis and avascular necrosis. Flexion deformities and DIP joint space narrowing were more seen in patients with dcSSc. Resorption of the distal ulna and avascular necrosis was observed more in lcSSc. There was a correlation between radiologic changes and duration, but not with the skin score. The most common capillaroscopic pattern in patients with radiologic change was late scleroderma pattern. Radiologic changes which were mostly asymptomatic were common in patients with SSc. The changes were different in patients with dcSSc and lcSSc and there were associations with duration and capillaroscopic patterns, but not with the skin score.