Search

Objective: To assess the clinical and radiographic features of hand involvement in patients with systemic sclerosis (SSc).Methods: Forty-one unselected Sardinian SSc patients (32 women, 9 men; mean age 58.9, range 31-81 years; mean disease duration 11.8 years, range 1-36 years) were evaluated in this observational cross-sectional study. Twenty-six patients had diffuse scleroderma (dSSc) and 15 limited scleroderma (lSSc). Radiological examination of the hands was performed and the films were read by two independent rheumatologists blinded to the diagnosis using a classification system of four predefined radiological patterns (normal/minimal changes, articular degenerative, articular inflammatory and periarticular pattern). Correlations between radiological pattern, clinical and serological features were assessed.Results: The skeletal and articular involvement of the hand was frequent in SSc, being clinically evident in 30/41 (73%) and radiologically in 33/41 (80%) of patients. The periarticular pattern (defined as the occurrence of bone resorption of ungueal tufts, soft tissue calcifications and/or flexion deformities) was the most frequent pattern detected (14/41, 34.1%) and finger flexion contractures and bone resorptions were significantly associated with interstitial lung disease, reduced FVC, oesophagus involvement and prostacycline therapy. Calcinosis (29.2%) was found to be associated with erosions, suggesting a pathogenic link. An inflammatory pattern was also radiologically frequent (8/41, 19.5%), but erosions, with the exception of those localized at distal interphalangeal joints, were demonstrated mainly in patients with clinical picture of rheumatoid arthritis overlapped with SSc. We found no significant differences in terms of radiographic findings between lSSc and dSSc with the exception of calcinosis, which was more frequent in patients with lSSc.Conclusion: This cross-sectional study confirms that the skeletal and articular involvement of the hand is frequent in SSc. [ABSTRACT FROM AUTHOR]

To our knowledge, only three cases of remitting symmetrical pitting oedema in systemic lupus erythematosus have been reported so far. This is the first report of two patients with asymmetrical pitting oedema and systemic lupus erythematosus. The first patient presented two consecutive episodes of unilateral oedema. The first episode involved the distal part of the right lower extremity and remitted spontaneously while the second involved the volar region of the left wrist and distal half of the forearm and promptly responded to steroids. Magnetic resonance imaging of the left wrist and forearm showed tenosynovitis of the flexor tendons and subcutaneous oedema. The second patient instead developed a single episode of pitting oedema of the distal part of the right lower extremity that resolved spontaneously. Magnetic resonance imaging of the right ankle and foot showed subcutaneous oedema without involvement of the tendon sheaths or osteoarticular and ligamental structures. These two cases suggest that pitting oedema in systemic lupus erythematosus may occasionally be asymmetric and associated or not with tenosynovitis.