Grenoble Alpes University Hospital, Hopital Sud, Rheumatology Department, CS 90338, 38434 Echirolles cedex, France.
Grenoble Alpes University Hospital, Hopital Sud, Rheumatology Department, CS 90338, 38434 Echirolles cedex, France.
Joint Bone Spine. 2020 May;87(3):229-233. doi: 10.1016/j.jbspin.2020.01.011. Epub 2020 Feb 9.
In systemic sclerosis, few studies have shown that hand and wrist ultrasound is more sensitive than clinical examination in the detection of synovitis and tenosynovitis. Even fewer studies have investigated ankle and foot involvement with ultrasound. Our objectives were to investigate ultrasound prevalence of wrist, hand, ankle and foot synovitis and tenosynovitis in patients with systemic sclerosis classified with ACR/EULAR 2013 criteria, and to study their relationship with disease features and hand disability.
Consecutive patients with systemic sclerosis, classified with ACR/EULAR 2013 criteria, were included in a monocentric cross-sectional study. They underwent standardized musculoskeletal clinical examination and hand, wrist, ankle and foot ultrasound. Clinical, biological and imaging data were also collected.
Fifty-five patients were included. Ultrasound was more sensitive than clinical examination to detect at least one synovitis (respectively 52% versus 25%, P=0.025) and at least one tenosynovitis (respectively 16% versus 4%, P=0.009); 18% of patients had ankle tenosynovitis and 29% had ankle and/or foot synovitis, mostly located at metatarsophalangeal joints (25.5%). Having at least one ultrasound hand synovitis was associated with higher Cochin hand functional disability scale (mean 25±3 versus 12±2, P=0.003) and diffuse cutaneous subset (P=0.038).
Our study shows that ultrasound is more sensitive than clinical examination to detect synovitis and tenosynovitis in systemic sclerosis. The foot involvement is less frequent than hand involvement, mainly localized at metatarsophalangeal joint. Finally, having at least one synovitis of the hand is associated with diffuse cutaneous subset and higher hand disability.
在系统性硬化症中，很少有研究表明手部和腕部超声在检测滑膜炎和腱鞘炎方面比临床检查更敏感。更少的研究调查了踝关节和足部的超声表现。我们的目的是研究符合 ACR/EULAR 2013 标准的系统性硬化症患者的腕部、手部、踝关节和足部滑膜炎和腱鞘炎的超声患病率，并研究其与疾病特征和手部残疾的关系。
我们纳入了一项单中心横断面研究中的符合 ACR/EULAR 2013 标准的连续系统性硬化症患者。他们接受了标准化的肌肉骨骼临床检查以及手部、腕部、踝部和足部超声检查。还收集了临床、生物学和影像学数据。
共纳入 55 例患者。超声比临床检查更敏感，可检测到至少一处滑膜炎（分别为 52%和 25%，P=0.025）和至少一处腱鞘炎（分别为 16%和 4%，P=0.009）；18%的患者有踝关节腱鞘炎，29%的患者有踝关节和/或足部滑膜炎，主要位于跖趾关节（25.5%）。至少有一处手部超声滑膜炎与更高的 Cochin 手部功能残疾量表（平均 25±3 与 12±2，P=0.003）和弥漫性皮肤亚型（P=0.038）相关。
我们的研究表明，超声比临床检查更敏感，可检测出系统性硬化症中的滑膜炎和腱鞘炎。手部受累比足部受累更常见，主要位于跖趾关节。最后，至少有一处手部滑膜炎与弥漫性皮肤亚型和更高的手部残疾相关。
