Background/Purpose: Joint involvement in SLE is the most frequent manifestation and shows a wide heterogeneity (1) . It has not a valid classification and it is often underestimated. Subclinical inflammatory musculoskeletal involvement is not well known (2). The objetive of the study was to describe the prevalence of joint and tendon involvement in hand and wrist of SLE patients, either with clinical arthritis, arthralgia or asymptomatic and compare it with healthy subjects using contrasted MR. Secondarily, only in SLE patients (N=83), study the relation between joint and tendon involvement confirmed by contrasted MRI and the patient related outcomes (PRO).

Methods: SLE patients fulfilling SLICC criteria were recruited and classified as follows: group (G) 1: hand/wrist arthritis, G2: hand/wrist arthralgia, G3: no hand/wrist symptoms. Jaccoud arthropathy, CCPa and RF positivity, hand OA or surgery were excluded. Healthy subjects (HS) were recruited as controls: G4. Contrasted MRI of non-dominant hand/wrist was performed. Images were evaluated following RAMRIS criteria extended to PIP, Tenosynovitis score for RA and peritendonitis from PsAMRIS. Groups were statistically compared. Different PRO: numeric scale (NE) of pain (0-10) and fatigue (0-3), Health Assessment Questionnaire (HAQ) and Fatigue Severity Scale (FSS-9) were collected in SLE patients and statistically analysed along with each MRI abnormality

Results: 107 subjects were recruited (G1: 31, G2:31, G3:21, G4:24). Any lesion: SLE patients 74.7%, HS 41.67%; p 0.002. Synovitis: G1: 64.52%, G2: 51.61%, G3: 45%, G4: 20.83%; p 0.013. Erosions: G1: 29.03%; G2: 54.84%, G3: 47.62%; G4: 25%; p 0.066. Bone marrow edema: G1: 29.03%, G2: 22.58%, G3: 19.05%, G4: 0.0%; p 0.046. Tenosynovitis: G1: 38.71%; G2: 25.81%, G3: 14.29%, G4: 0.0%; p 0.005. Peritendonitis: G1: 12.90%; G2: 3.23%, G3: 0.0%, G: 0.0%; p 0.07.

In SLE patients (N=83), patients with synovitis, tenosynovitis, peritendonitis and bone marrow edema reported higher values in pain NE (6.03±2.57 vs 4.26±2.49, p 0.005; 6.56±1.95 vs 4.76±2.75, p 0.017; 8.80±1.30 vs 4.95±2.55, p 0.001; 6.47±2.62 vs 4.83±2.58, p 0.026); patients with synovitis reported higher values in fatigue EN (2.32±0.82 vs 1.91±0.84, p 0.035) and patients with tenosynovitis showed worse FSS-9 (61.50±1.73 vs 45.70±16.80, p 0.015) versus patients who did not show these abnormalities by MRI. Patients with synovitis and peritendonitis had a worse HAQ (1.14±0.69 vs 0.75±0.65, p 0.031; 1.69±0.07 vs 0.90±0.69, p 0.018).

Conclusion: SLE patients have a high prevalence of inflammatory musculoskeletal alterations by contrasted MRI, even if asymptomatic. Not only tenosynovitis but peritendonitis is also present. SLE patients with joint and/or tendon involvement confirmed by contrast enhanced MRI have a worse HRQoL measured by pain, fatigue and functional disability

References
1. Ceccarelli F et al. Joint involvement in systemic lupus erythematosus: From pathogenesis to clinical assessment. Semin Arthritis Rheum. 2017;47:53-64
2.Di Matteo A et al. Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus. Curr Rheumatol Rep. 2021;23:73

ACR Meeting Abstracts - https://acrabstracts.org/abstract/contrast-enhaced-articular-magnetic-resonance-imaging-mri-and-health-related-quality-of-life-in-sle-patients/