Department of Internal Medicine and Rheumatology, Kerckhoff-Klinik, Justus-Liebig University Gießen, Germany.
Eur J Intern Med. 2012 Jan;23(1):e25-9. doi: 10.1016/j.ejim.2011.09.010. Epub 2011 Oct 20.
Systemic sclerosis (SSc) is a connective tissue diseases characterised by excessive thickening of the dermis in addition to affection of internal organs. Many patients experience musculoskeletal symptoms, but arthritis is still considered to be a rare manifestation. Therefore, we analysed a cohort of SSc patients in our department and related the findings to published data.
Clinical data on inpatients with SSc between February 2007 and February 2008 were analysed retrospectively for the presence of clinically overt and documented arthritis. In addition, X-rays of these patients were reassessed. A systematic literature search using PubMed was performed to find studies on arthritis in SSc patients; suitable studies were included in a meta-analysis based on the random-effect-model. The search terms were scleroderma, systemic sclerosis, arthritis, inflammatory joint disease, hand involvement, foot involvement and musculoskeletal findings in various combinations. Original articles not written in English and articles which were not dealing with arthritis in SSc patients were excluded from the study. We included articles in which the examined cohorts corresponds to the ACR- or LeRoy criteria for SSc and arthritis was diagnosed based on clinical and/or radiological data. All manuscripts were read and reviewed by two independent investigators.
In our cohort of 58 patients, 31% had signs of arthritis, 19% clinically and 26% radiologically. In a meta-analysis of 7 studies, a prevalence of 26% (95% CI [16.7, 36.1]) for radiologically detectable arthritis in SSc patients was observed. For clinical arthritis, the prevalence was calculated to be 23% (95% CI [14.9, 30.9]). Of interest, no difference in the occurrence of arthritis in diffuse and limited SSc was observed radiologically (OR=1.1, 95% CI [0.47, 2.57]) or clinically (OR=1.11, 95% CI [0.6, 2.05]).
Arthritis is frequent manifestation of SSc. Its role in joint dysfunction has to be established in further studies.
系统性硬化症（SSc）是一种结缔组织疾病，其特征除了内脏器官受累外，还表现为真皮过度增厚。许多患者有肌肉骨骼症状，但关节炎仍被认为是一种罕见的表现。因此，我们分析了我科的一组 SSc 患者，并将这些发现与已发表的数据进行了比较。
回顾性分析 2007 年 2 月至 2008 年 2 月间住院的 SSc 患者的临床资料，以确定是否存在临床明显和有记录的关节炎。此外，还重新评估了这些患者的 X 光片。使用 PubMed 进行了系统性文献检索，以寻找 SSc 患者关节炎的研究；根据随机效应模型，将合适的研究纳入荟萃分析。检索词包括硬皮病、系统性硬化症、关节炎、炎症性关节病、手部受累、足部受累和各种组合的肌肉骨骼表现。未用英文撰写的原始文章和未涉及 SSc 患者关节炎的文章均被排除在研究之外。我们纳入的文章中，检查队列符合 ACR 或 LeRoy 对 SSc 的标准，关节炎是根据临床和/或放射学数据诊断的。所有文章均由两位独立的研究人员阅读和审查。
在我们的 58 例患者队列中，31%有关节炎迹象，19%为临床表现，26%为放射学表现。在对 7 项研究的荟萃分析中，观察到 SSc 患者放射学上可检测到的关节炎的患病率为 26%（95%CI[16.7，36.1]）。对于临床关节炎，患病率估计为 23%（95%CI[14.9，30.9]）。有趣的是，在放射学和临床方面，弥漫性和局限性 SSc 患者关节炎的发生率没有差异（OR=1.1，95%CI[0.47，2.57]）或临床（OR=1.11，95%CI[0.6，2.05]）。
关节炎是 SSc 的常见表现。其在关节功能障碍中的作用需要在进一步的研究中确定。
