Ultrasonographic evaluation of arthropathy findings in patients with systemic sclerosis

Aim: Ultrasonography (US) in patients with systemic sclerosis (SSc) is used to evaluate periarticular soft tissues and detect inflammatory lesions (synovitis, tenosynovitis, bursitis, etc.); Power Doppler Ultrasound (PDUS) allows evaluating the vascularity in the examined area and detecting signs of active inflammation. The aim of this study is to define the frequency and severity of hand and wrist synovitis and/or tenosynovitis with US in patients with SSc, to investigate the frequency and severity of PDUS signals in joints with synovitis and/or tenosynovitis, to compare the data obtained with the data of the healthy control group, to examine all US data, to investigate the relationship of findings with clinical examination, biological data and visceral involvement. Materials and Methods: The study was conducted prospectively with 50 patients diagnosed with SSc and 50 Control Groups. Synovitis, synovial hypertrophy, tenosynovitis, erosion, osteophytes and calcinosis were detected by US in the 2nd, 3rd, 4th and 5th fingers Metacarpophalengeal (MCP), Proximal interphalangeal (PIP) and Distal interphalangeal (DIP) joints of both hands and wrist joints of a total of 100 volunteers was evaluated for its presence. Joints with synovitis and/or tenosynovitis were evaluated in terms of synovitis and/or tenosynovitis severity and PDUS signal positivity as 0=none, 1=minimal, 2=moderate, 3=severe. Results: 50 SSc patients were included in the study, 41 (82%) patients were female and 9 patients (18%) were male. The control group of the 50 healthy individuals, 41 (82%) healthy individuals were female and 9 (18%) healthy individuals were male. The average age of SSc patients was 53.7 ± 12.1 years, and the average age of the healthy control group was 53 ± 12.2 years. There was no statistically significant gender and age difference between the groups. The incidence of synovitis (p<0.001), synovial hypertrophy (p<0.001), tenosynovitis (p<0.001) and calcinosis (p < 0.012) in the joints examined on US in patients with SSc was found to be significantly higher than in the healthy control group, numerically and statistically. In patients with SSc, synovitis, synovial hypertrophy and tenosynovitis were detected more frequently in the wrist compared to other joints examined. The comparison made between patients with SSc and the control group in terms of detecting synovitis (p < 0.001), synovial hypertrophy (p < 0.001) and tenosynovitis (p < 0.001) in the wrist joint with USG was found to be statistically significant in favor of patients diagnosed with SSc. Additionally, in the comparison between patients with SSc and controls, the frequency of mild synovitis (p < 0.001) and mild tenosynovitis (p < 0.001) detected in all joints by USG were found to be statistically significant in favor of patients diagnosed with SSc. Quantitatively, no evidence of severe (Grade 3) synovitis or tenosynovitis or severe (Grade 3) PD positivity was found in the patients and controls. Furthermore, in the comparison made between patients belonging to DcSSc and LcSSc subtypes, no statistically significant difference was found in terms of US findings. In our study, when comparing SSc patients without and with synovitis, it was observed that those with synovitis had higher CRP (CRP>5 mg/dl) and higher ESR values than those without synovitis, which was statistically significant (p=0.039 and p=0.025, respectively). Conclusion: In this study, a higher incidence of synovitis, synovial hypertrophy and tenosynovitis findings were found using US, particularly in the wrist, in SSc patients compared to healthy controls. It was observed that minimal synovitis-tenosynovitis findings were more common in SSc patients than moderate-severe synovitis-tenosynovitis, and the frequency of minimal synovitis and tenosynovitis was observed to be higher than the healthy control group. The finding of synovitis was considered to be associated with higher CRP and sedimentation values in the patients. Key Words: Systemic Sclerosis, Ultrasonography, Synovitis and Tenosynovitis, Power Doppler Ultrasonography