Objective The objective of this study was to explore the etiologies and contributing factors of synovial and tenosynovial involvement in SSc, as well as to assess the phenotype of patients with these synovial and tenosynovial features. Methods 171 SSc patients with hand manifestations (either vascular, skin or joint manifestations) who underwent standard X-rays of both hands and hand ultrasound (US), were included. Two independent evaluators recorded the presence or absence of acro-osteolysis, calcinosis, microcrystalline and degenerative rheumatisms, including osteophytosis on X-Rays. The presence of synovitis and tenosynovitis (active or fibrotic) was assessed through US by a third evaluator, blinded for X-ray parameters. Results In multivariate analysis, the characteristics associated with active synovitis and tenosynovitis were CRP>10mg/L (p = 0.013), fibrotic tenosynovitis on US (p = 0.005), anti-RNA polymerase III antibodies (p = 0.043) and poly-osteophytosis on hand X-rays (p = 0.001). After exclusion of patients with RA (n = 5) and/or poly-osteophytosis (n = 53), 14 remaining patients (12.7%) had active synovitis and/or tenosynovitis on US. In multivariate analyses, parameters associated with active synovitis and/or tenosynovitis in this selected population were scleroderma renal crisis (p = 0.012) and fibrotic tenosynovitis on US (p < 0.001). Conclusion Our study confirms that osteophytosis is a significant contributor of joint involvement in SSc patients based on real life data. After exclusion of potential confounders, more than 10% of SSc patients still had active synovitis and/or tenosynovitis on US, providing indirect evidence for the existence of a specific SSc-related synovial and/or tenosynovial involvement.

中文翻译：

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结合放射学和超声评估，以破译系统性硬化症患者手部关节受累情况


目的 本研究的目的是探讨滑膜和腱鞘受累 SSc 的病因和影响因素，以及评估具有这些滑膜和腱鞘特征的患者的表型。方法 纳入 171 例有手部表现 （血管、皮肤或关节表现） 的 SSc 患者，他们接受了双手标准 X 光检查和手部超声 （US）。两名独立评估者记录了 X 光片上是否存在肢端骨溶解、钙质沉着症、微结晶和退行性风湿病，包括骨赘病。滑膜炎和腱鞘炎（活动性或纤维化）的存在由第三名评估员通过 US 评估，对 X 射线参数不知情。结果 在多变量分析中，与活动性滑膜炎和腱鞘炎相关的特征为 CRP>10mg/L （p = 0.013）、US 纤维化腱鞘炎 （p = 0.005）、抗 RNA 聚合酶 III 抗体 （p = 0.043） 和手部 X 光片上的多骨赘病 （p = 0.001）。在排除 RA （n = 5） 和/或多骨赘症 （n = 53） 患者后，其余 14 例患者 （12.7%） 在 US 上患有活动性滑膜炎和/或腱鞘炎。在多变量分析中，与该选定人群的活动性滑膜炎和/或腱鞘炎相关的参数是硬皮病肾危象 （p = 0.012） 和 US 纤维化腱鞘炎 （p < 0.001）。结论 我们的研究证实，基于真实生活数据，骨赘病是 SSc 患者关节受累的重要贡献者。在排除潜在的混杂因素后，超过 10% 的 SSc 患者在 US 上仍存在活动性滑膜炎和/或腱鞘炎，为存在特定的 SSc 相关滑膜和/或腱鞘受累提供了间接证据。