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. 2021 Aug;51(4):735-740.
doi: 10.1016/j.semarthrit.2021.04.020. Epub 2021 May 8.

Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints

Robert Fairchild  1 , Audra Horomanski  2 , Laurel Sharpless  2 , Melody Chung  2 , Shufeng Li  3 , Jison Hong  2 , Khushboo Sheth  4 , Lorinda Chung  4
Affiliations

Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints

Robert Fairchild et al. Semin Arthritis Rheum. 2021 Aug.

Abstract

Objective: To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc).

Methods: The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed.

Results: TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (κ=0.88) as well as TJs (κ=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p = 0.018) as well as higher osteophyte severity (p = 0.033).

Conclusions: Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.. Heat map of ultrasound and clinical examination findings
Each row corresponds to unique systemic sclerosis (SSc) patients or healthy controls. Rows 1–17 = limited SSc; rows 18–43 = diffuse SSc; rows C01–C35 = healthy controls. For gray scale score and power doppler score: white = 0, yellow =1, orange =2, and red =3. For tender joints, swollen joints, erosions, and osteophytes: white = absent, black = present. Left and right laterality for each consolidated joint region were combined for visualization in this figure but were preserved for all statistical analyses.
Figure 2.
Figure 2.. Osteophyte severity among SSc patients and controls with osteophytes.
Osteophyte severity score calculated by summing individual joint region scores per patient. Median with interquartile range shown. Comparison of osteophyte severity by Wilcox rank-sum test. SSc = systemic sclerosis.
Figure 3.
Figure 3.. Degrees of osteophytosis on ultrasound imaging of the distal interphalangeal joint in patients with systemic sclerosis
Ultrasound imaging of the volar aspect of the distal interphalangeal joint (DIP) in systemic sclerosis in A) a normal joint, B) moderate osteophytosis, and C) severe osteophytosis and synovitis with the appearance of inflammatory osteoarthritis with doppler activity. FT = flexor tendon, MP = middle phalanx, DP = distal phalanx, OS = osteophytes, green arrowheads = synovial border.
See this image and copyright information in PMC

Comment in

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