[2008] [OP-0194] ARTICULAR INVOLVEMENT IN SYSTEMIC SCLEROSIS

M. Starovoitova, T. Nevskaya, O. Desinova, L. Ananieva, N. Guseva Microcirculation and inflammation, State Institute of Rheumatology of RAMS, Moscow, Russian Federation

Background: Articular involvement is the most frequent after Raynaud's phenomenon and early manifestation of systemic sclerosis (SSc). It varies from transient arthralgia to severe joint deformation leading to functional disability of SSc patients, but the clinical features of articular disease in limited (lSSc) and diffuse (dSSc) subtypes, underlying morphological lesions of articular and extra-articular structures, as well as diagnostic value and clinical outcome remain unknown in SSc.
Objectives: The aim of the study was to characterize the articular involvement in SSc patients.
Methods: 217 consecutive SSc patients fulfilled ACR criteria were clinically assessed and prospectively followed up (mean 7 yrs) by the same rheumatologists for the presence and characteristics of articular disease, joint tenderness evaluation by the Richie score index and VAS for pain, functional disability measured with HAQ and destructive X-ray joint changes. Magnetic resonance imaging (MRI) and ultrasonography (US) studies were used to assess the articular and extraarticular inflammatory lesions.
Results: Articular symptoms were observed in 70% of early SSc pts. The frequency (68% vs 75%) and pattern of affected joints did not differ between dSSc and lSSc: bilateral knees (65% vs 47%), ankles (47% vs 29%) and small hand joints (50% vs 31%) were most often involved. In dSSc group the articular manifestations appeared simultaneously with the onset of skin changes in 52% of cases or accompanied the progression of skin involvement (39%), both indicating a high disease activity. In lSSc pts articular symptoms more often proceeded skin edema (26% vs 9%, p<0.05). 52% of SSc pts showed oligoarticular and 48% -polyarticular involvement. 22% of dSSc pts and none of lSSc pts had mialgia in combination with arthralgia. SSc pts experienced two variants of arthtitis: 1) predominance of fibrotic induration of articular and periarticular soft tissues, leading to joint contractures, accompanied by persistent low-grade pain and mild morning stiffness, without bone destruction; most often variant; onset at any time during SSc course; 2) symmetric US-confirmed inflammatory joint lesions that mimic RA clinically, but with less severe inflammation and in the most cases without destructive joint changes characteristic for RA; most pronounced in early SSc. Among the last group, 19 SSc pts fulfilled ACR criteria for the diagnosis of RA, 56% of them developed arthritis at the first year after disease onset and experienced the following clinical features: 1) the total numbers of painful joints varied from 4 to 32 (15±6); total numbers of swollen joints - from 2 to 24 (11±5). 2) pain assessment by VAS was within 5.1-8.4 (6.8± 0.9) sm. with functional impairment measured with HAQ - from 0,5 to 2; 3) 81% had contractures of small hand joints, less often of shoulders and elbows (6%), ulnar hand deviation were found in 44% of pts and muscle atrophy - in 94%; 4) 82% of them showed X-ray signs of joint destruction with multiple bone erosions in 32% of cases.
Conclusion: We described two variants of SSc articular involvement with different mode of presentation, clinical features, pace of progression, degree of functional disability, underlying MRI and US findings that may help in early SSc diagnostics and correct assessment of disease activity.

Ann Rheum Dis 2008;67(Suppl II):110

Abstract Session: Scleroderma and myositis