Background/Purpose: Calcinosis is a vexing manifestation in patients with systemic sclerosis (SSc) with a variable prevalence among cohorts. Up to 86% of calcinosis cases are localized in the hands. This study aims to evaluate the prevalence of calcinosis on hand radiographs in a cross-sectional cohort of SSc patients at their initial evaluation and to compare clinical and laboratory features between those with and without calcinosis.

Methods: We conducted a retrospective cohort study using data from the Mayo Clinic Arizona Scleroderma Program. Only patients who underwent bilateral hand X-rays as part of baseline evaluation were included. Demographic data, clinical features, laboratory results, and treatment were collected. Descriptive statistics were stratified by calcinosis status. Categorical variables were summarized as counts and percentages, with group differences assessed using Chi-square or Fisher’s exact tests. Continuous variables were reported as means with standard deviations; comparisons were made using two-sample t-tests.

Results: Of the 196 patients in our cohort who had hand x-rays, 71 (36.2%) showed evidence of calcinosis. Demographic characteristics and SSc subtypes are summarized in Table 1. Patients with calcinosis had a longer time from scleroderma diagnosis to hand X-rays (12.7 vs. 7.3 years, p = 0.001). Compared to those without calcinosis, patients with calcinosis had higher rates of acroosteolysis, finger ulcers, joint contractures, telangiectasias, and osteopenia (Table 2). There were no significant differences between the groups in the prevalence of Raynaud’s phenomenon, ILD, pulmonary arterial hypertension, or renal involvement. Serologically, anti-Scl-70 antibodies were more common in patients without calcinosis (27.2% vs. 14.1%, p = 0.034), whereas anti-centromere (49.3% vs. 34.4%, p = 0.041) and anti-SS-A 52kD antibodies (19.7% vs. 8.0%, p = 0.023) were more frequent in those with calcinosis. Medication use is detailed in Table 3.

Conclusion: In a single center cohort of SSc patients, calcinosis on bilateral hand X-rays was observed in over one-third (36.2%) of patients. This is a higher prevalence compared to 10% in prior literature. Calcinosis was associated with a longer time from scleroderma diagnosis to hand X-rays, suggesting it progresses over time and may explain variation in prevalence based on radiograph timing. Osteopenia was more frequent among patients with calcinosis, although calcinosis was not significantly associated with vitamin D deficiency or hyperparathyroidism. These findings are consistent with other studies where bone metabolism might be playing a role in the pathogenesis of calcinosis. Higher frequencies of anti-centromere and anti-SS-A 52kD antibodies were seen in patients with calcinosis, whereas anti-Scl-70 antibodies were more common in those without calcinosis. This highlights an opportunity to explore serologic distinctions in larger cohorts. This study highlights the high prevalence of calcinosis detected on baseline hand X-rays suggesting that imaging may serve as a valuable tool for early detection. Consistent early identification is required to better understand calcinosis before exploring targeted interventions for the future.

Table 1. Clinical characteristics of sleroderma patients with and without calcinosis

Table 2. Associated symptoms and system involvement in scleroderma patients with and without calcinosis

Table 3. Medications used in patients with and without calcinosis

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/exploring-calcinosis-on-hand-x-rays-in-systemic-sclerosis-a-mayo-clinic-cohort/