Background/Purpose: We have used digital mammographic soft tissue Xrays of the fingers from patients with Scleroderma and related conditons to show damage related to the disease.  Images clearly show skin thickening, fibrosis of subcutaneous tissues, calcinosis, tuft resorption and loss of tissue from the finger tips.  In this study we developed a scoring sytem to give a semi-quantitative measure of these changes to investigate the hypothesis that this method could be used as a damage index and outcome measure in Scleroderma.

Methods: A Sectra Microdose C30 machine was used to take digital soft tissue images with four-finger AP views and lateral views of the index and middle fingers.  Images were viewed by 2 authors and consensus reached on mild, moderate and severe changes (scored 1,2,3) for fibrosis, calcinosis and tuft resorption.  Skin thickness was measured at 3 sites in each finger and averaged.  Loss of tissue at the fingertip was measured according to Yune et al.  Measurements were converted to scores for consistency.

Results: Xrays were scored for 6 normal subjects, 15 with lcSSc, 1 MCTD (included with lcSSc) and 7 dcSSc.  Scores for calcification were higher in lcSSc for calcification: 1.2 vs 0.8 for dcSSc.  Scores for tuft resorption and skin thickening were higher in dcSSc vs lcSSc: 1.8 vs 1.1 and 1.9 vs 1.1.  Total damage scores were 0.17±0.1, 6.3±3.8 and 7.6±3.0 for normals, lcSSc and dcSSc respectively.  These values were not statistically different.  However, subjects with dcSSc had significantly more damage per year of disease duration: 1.2±0.8 vs 0.4±0.3, p=0.03.

Conclusion: We have explored the possibility that soft tissue Xrays of the fingers taken using digital mammographic methods could be used to produce a semiquantitative measure of tissue damage in Scleroderma, akin to a Sharp Index in RA.  The fact that we were able to demonstrate significantly faster accumulation of damage with dcSSc compared to lcSSc even in a small number of subjects provides proof of the concept and warrants further development of this method as an outcome measure in Scleroderma.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/measurement-of-tissue-damage-in-scleroderma-using-digital-mammographic-xrays-a-proof-of-concept-study/