Scleroderma Damage in Hands Better Assessed with Ultrasonographic Scans

New research on musculoskeletal ultrasound (MSUS) hand features in systemic sclerosis (SSc) or scleroderma and rheumatoid arthritis (RA) entitled “A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: Relation to disease activity, clinical and radiological findings” was recently published in the journal The Egyptian Rheumatologist by Dr. Nabila Gohar and led by Dr. Yasser Ezzat, both from the Rheumatology and Rehabilitation Department at Cairo University in Egypt, along with colleagues.

Systemic sclerosis (SSc) is a clinically heterogeneous disorder affecting the connective tissue of the skin, wall of the blood vessels and internal organs, like the gastrointestinal tract, lungs, heart, and kidneys. Rheumatoid arthritis (RA) is an autoimmune inflammatory and debilitating disease that leads to joint damage and higher risk for cardiovascular disease, affecting about 1% of adults in western countries, mainly women. In SSc and RA, radiographic studies have shown that in both conditions the most affected body regions are the joints, soft tissue, and bones of the hands.

Radiographs have some limitations in respect to sensitivity, mainly in detecting early inflammatory changes, such as effusion or synovitis, meaning liquid accumulation in the synovial sac or inflammation of the synovial membrane lining the joint, and so it is not possible to evaluate tendon damage. Radiographic and clinical evaluations are not perfect in assessing the entire spectrum of articular involvement in SSc and RA.

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The research team compared ultrasonographic (US) hand features in 40 systemic sclerosis (SSc) and 30 rheumatoid arthritis (RA) patients and evaluated their association with disease activity, clinical and radiographic data. All the patients were examined clinically, and X-ray and ultrasonographic scans were done on the hand and wrist joints to detect synovitis, tenosynovitis (inflammation of fluid-filled sheath surrounding a tendon), and calcinosis (calcium deposits in soft tissues).

The researchers found that cases of synovitis and tenosynovitis detected by US were higher in number than those found by clinical examination in both RA and SSc patients. Sclerosing tenosynovitis seemed to be specific to SSc patients and calcifications were observed similarly in both conditions.

Overall, the researchers concluded that ultrasonographic scans gave important disease activity information in both patients with RA and SSc more than clinical examination and articular involvement in SSc is less common that in RA.