Presentation: Chronic Articular Involvement In Systemic Sclerosis (2007)

7 Chronic Articular Involvement In Systemic Sclerosis

OBJETIVE: To analyze the pattern of chronic articular involvement, clinical associations and radiological characteristics in a large series of systemic sclerosis (SSc) patients.
PATIENTS AND METHODS: All patients diagnosed of SSc in a university hospital between 1976 and 2006 were included. Demographic (gender, age at initial symptoms and diagnosis, years of follow-up, death), clinical features (skin disease extension, presence of lung, renal, cardiac, muscular, articular and gastrointestinal disease), and serological features (ESR, RF, ANA, a-Scl70, ACA, a-RNP, a-CCP) were obtained from existing databases and from the patients charts. Chronic articular involvement was defined as arthritis or inflammatory arthralgia lasting more than 6 weeks. Tendon friction rubs and other causes of articular pain (osteoarthritis, crystal arthropahies, septic arthritis) were excluded. For the purpose of the study, the following data were obtained: number of painful and swollen joints, duration of morning stiffness, pattern of articular involvement and radiological features (Sharp/Van der Heijde index, presence of osteopenia and calcinosis). Bivariate Odds ratio with 95% CI was used to measure the strength of association between variables, and logistic regression to analyze risk factors for erosions.
RESULTS: From 180 SSc patients (163 f, 17 m), with 44±18 y at initial symptoms and 7.1±6.5 y of follow-up, 89 (49%) had chronic articular involvement. Fifty five (62%) patients had limited and 34 (38%) diffuse SSc, 81 (91%) had ANA, 30 (34%) ACA, 28% Scl-70, 8% RNP and 13% RF. Articular involvement presented as inflammatory arthralgia in 51 (57%) and as chronic arthritis in 38 (43%) patients. In this last group, arthritis was bilateral and symmetrical in 35 (90%) patients, with 12±9 tender and 7±8 swollen joints, and was the initial symptom in 14 (36%). More frequently affected joints were: wrist (30%), knee (21%), MCP (16%), PIP (10%) elbows (8%) and shoulders (5%).ESR was elevated in 13 (34%) patients, RF was positive in 6 and a-CCP in 2. Radiological findings were osteopenia (25%), erosions (18%) and calcinosis (8%). Sharp/VdH index was 5.5±8.6 for joint space narrowing and 0.7± 2,7 for erosions. Arthritis was associated with colon involvement (OR=2.1; CI 1-4.5; p=0.04) sicca syndrome (OR=2.4; CI 1-5.7; p=0.03), elevated ESR (OR=2.5; CI 1.1-5.3; p=0.01), absence of ACA (OR=0.5; CI 0.2-0.9; p=0.03), but not with RF or CCP. Patients with articular disease received more steroids, chloroquine and D-PNC than patients without articular symptoms. None of the clinical characteristics analyzed was able to predict erosion development in our group of patients.
CONCLUSION: Articular disease appears in almost half of SSc patients in our series. The predominant clinical pattern is similar to that of rheumatoid arthritis, with bilateral and symetrical hand involvement. but with much less severe radiological damage and no association with RF. Articular involvement was nevertheless associated to sicca syndrome, elevated ESR and absence of ACA.

 B.E. Joven, None; R. Almodovar, None; E. Enriquez, None; P.E. Carreira, None.