Combined radiographic and ultrasound evaluations to decipher joint involvement in the hands of patients with systemic sclerosis

IF 4.7 2区 医学 Q1 RHEUMATOLOGY Rheumatology Pub Date : 2024-10-29 DOI:10.1093/rheumatology/keae602
Marine Tas, Romain Lecigne, Nicolas Belhomme, François Robin, Thibaut Louis, Antoinette Perlat, Claire Cazalets, Guillaume Coiffier, Alain Lescoat
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Abstract

Objective The objective of this study was to explore the etiologies and contributing factors of synovial and tenosynovial involvement in SSc, as well as to assess the phenotype of patients with these synovial and tenosynovial features. Methods 171 SSc patients with hand manifestations (either vascular, skin or joint manifestations) who underwent standard X-rays of both hands and hand ultrasound (US), were included. Two independent evaluators recorded the presence or absence of acro-osteolysis, calcinosis, microcrystalline and degenerative rheumatisms, including osteophytosis on X-Rays. The presence of synovitis and tenosynovitis (active or fibrotic) was assessed through US by a third evaluator, blinded for X-ray parameters. Results In multivariate analysis, the characteristics associated with active synovitis and tenosynovitis were CRP>10mg/L (p = 0.013), fibrotic tenosynovitis on US (p = 0.005), anti-RNA polymerase III antibodies (p = 0.043) and poly-osteophytosis on hand X-rays (p = 0.001). After exclusion of patients with RA (n = 5) and/or poly-osteophytosis (n = 53), 14 remaining patients (12.7%) had active synovitis and/or tenosynovitis on US. In multivariate analyses, parameters associated with active synovitis and/or tenosynovitis in this selected population were scleroderma renal crisis (p = 0.012) and fibrotic tenosynovitis on US (p < 0.001). Conclusion Our study confirms that osteophytosis is a significant contributor of joint involvement in SSc patients based on real life data. After exclusion of potential confounders, more than 10% of SSc patients still had active synovitis and/or tenosynovitis on US, providing indirect evidence for the existence of a specific SSc-related synovial and/or tenosynovial involvement.
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结合影像学和超声波评估,解读系统性硬化症患者手部关节受累情况
目的 本研究旨在探讨 SSc 患者滑膜和腱鞘受累的病因和诱因,并评估具有这些滑膜和腱鞘特征的患者的表型。方法 纳入171名有手部表现(血管、皮肤或关节表现)的SSc患者,这些患者均接受了标准的双手X光检查和手部超声检查(US)。两名独立的评估人员记录了X光片上是否存在尖锐骨溶解、钙化、微晶和退行性风湿,包括骨质增生。是否存在滑膜炎和腱鞘炎(活动性或纤维化)由第三位评估者通过 US 进行评估,该评估者对 X 射线参数保密。结果 在多变量分析中,与活动性滑膜炎和腱鞘炎相关的特征有:CRP>10mg/L(p = 0.013)、X线片上的纤维化腱鞘炎(p = 0.005)、抗RNA聚合酶III抗体(p = 0.043)和手部X线片上的多发性骨质增生(p = 0.001)。在排除患有 RA(5 例)和/或多发性骨质增生(53 例)的患者后,剩下的 14 例患者(12.7%)在 US 检查中发现有活动性滑膜炎和/或腱鞘炎。在多变量分析中,在这一选定人群中,与活动性滑膜炎和/或腱鞘炎相关的参数是硬皮病肾危象(p = 0.012)和 US 上的纤维化腱鞘炎(p &;lt;0.001)。结论 我们的研究根据现实生活中的数据证实,骨质增生是导致 SSc 患者关节受累的一个重要因素。在排除了潜在的混杂因素后,10% 以上的 SSc 患者在 US 上仍有活动性滑膜炎和/或腱鞘炎,这为特定 SSc 相关滑膜和/或腱鞘受累的存在提供了间接证据。
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来源期刊
Rheumatology
Rheumatology 医学-风湿病学
CiteScore
9.40
自引率
7.30%
发文量
1091
审稿时长
2 months
期刊介绍: Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.
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