Background/Purpose: Arthralgia is frequent in patients with systemic sclerosis (SSc). However, correct clinical assessment of arthritis remains a challenge especially in patients with severe soft tissue edema and/or scleroderma. This study investigates the frequency of arthritis in SSc using musculoskeletal ultrasound (MSUS) compared to clinical investigation and in SSc.

Methods: Synovitis in B- and PD-mode as well as effusion was assessed in 56 consecutive patients with SSc using MSUS. Wrist, finger, upper and lower ankle joints as well as metatarsophalangeal (MTP) joints were scanned totaling 2016 joints. In all patients carotid intima media thickness (CIMT) as well as prevalence of carotid plaques was assessed by Doppler ultrasound. Arthritis disease activity was evaluated by the health assessment questionnaire (HAQ), and the DAS66/68. Joint pain and patient global health (PGH) were quantified on a visual analogue scale (VAS). Skin involvement was quantified using the modified Rodnan Skin Score (mRSS). CVRF such as smoking, hypertension or positive family history were recorded.

Results: All patients were negative for ACPA and rheumatoid factors. 15/56 patients had elevated CRP-levels. Doppler ultrasound found 12 pathological CIMT in 10 individual patients; 44/112 carotid arteries had at least one plaque. Patients with CIMT and/or carotid plaques were elderly (62.3 years +/- 11.02), long term sick (148.61 +/- 127.58 months), and had at least one cardiovascular risk factor. 8/15 CRP-positive patients had carotid plaques (53.3% vs 4.88% CRP-negative), and had a significantly higher number of CVRF than CRP-positive patients without carotid plaques (median 3.5 [1-5] vs. 1[0-5]). A cutoff diameter of >13mm2 was deemed pathologic for median nerves, >11mm2 and <13mm2 was intermediate. 11/56 patients had either pathologic or intermediate median nerves. 46.43% (n=26) of patients had joint pain, 16.07% (n=9) clinical joint swelling. In MSUS, 167 joints with effusion were detected in 38 patients (I°: n=93 joints, II°: n=74 joints). 36 joints in 17 patients were detected by B-mode synovitis (I°: 13 joints, II°: 23 joints). 12 joints in 5 patients showed PD-synovitis (I°: 4 joints, II°: 8 joints). In 15 patients MSUS could detect effusion where clinical examination could not; none of the clinically suspicious joints had effusion in MSUS. B-mode synovitis was detected in 5 clinically normal patients, in 7 patients with joint pain, and in 5 patients with joint pain and swelling. The overall correlation of MSUS with clinical examination was poor (p>0.05). B-mode synovitis and PD-mode synovitis prevailed the MTPs (69.44%, n=25 and 58.33%, n=7, respectively).

Conclusion:

In patients with arthralgia MSUS could detect clinically inapparent arthritis. Especially in joints with soft tissue edema and sclerotic skin MSUS was superior to clinical examination. Interestingly, arthritis was most frequently found in the MTP and wrist joints supporting recent data (Iagnocco 2013). In this small cohort there was no significant correlation between CRP positivity and arthritis. Not surprisingly, carotid plaques were more frequent in elderly, long-term patients with over 1 CVRF.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/superiority-of-musculoskeletal-ultrasound-msus-over-clinical-examination-regarding-detection-of-arthritis-in-patients-with-systemic-sclerosis/