Hand and wrist musculoskeletal changes in systemic sclerosis patients

Aim of the work: To study hand and wrist musculoskeletal changes among systemic sclerosis (SSc) patients. Patients and methods: Thirty adult SSc patients were enrolled and subjected to detailed medical history, clinical examination, laboratory investigations, and imaging studies including X-ray and musculoskeletal ultrasound (MSUS) on both hands and wrists. Results: The mean age of the studied patients was 40 +/- 9.9 years, disease duration 5.4 +/- 4.1 years and 28 (93.3 %) were females. Joint space narrowing (JSN) was the commonest finding in plain X-ray being detected in 9 (30 %) patients affecting mostly metacarpophalangeal joints (MCPs). Other X-ray findings included erosions (13.3 %), osteophytes (6.7 %), calcinosis (10 %), acro-osteolysis (13.3 %), and flexion contractures (3.3 %). Tenosynovitis was the most prevalent finding in MSUS detected in 43.3 % with the sclerosing pattern being the dominant type affecting mainly extensor tendons. 23.3 % of patients had active wrist synovitis, while 13.3 % of patients had wrist effusion, 13.3 % had MCP erosions, 13.3 % had MCP JSN, and 10 % had osteophytes. Patients who had no arthritis on presentation had a higher frequency of digital ulcers and tenosynovitis. Regression analysis showed that lack of hydroxychloroquine and methotrexate intake, absence of digital ulcers, presence of morning stiffness, erythrocyte sedimentation rate (ESR) > 27 mm/h and C-reactive protein (CRP) > 9 mg/dL, JSN by X-ray and absence of tenosynovitis by US were associated with arthritis. Conclusion: Articular involvement in SSc is frequent and could be the main presenting symptom. Clinical examination, ESR and CRP testing, along with plain radiography, and musculoskeletal ultrasonography are important to detect arthritis early and treat accordingly.