Cancellous bone-like tissue replacement from calcinosis in patients with systemic sclerosis with multiple external...

Area of Science:

• Rheumatology
• Radiology
• Oral and Maxillofacial Surgery

Background:

• Calcinosis is a common complication in systemic sclerosis (SSc), lacking established treatments.
• Multiple external root resorption (MERR) is a newly identified symptom in SSc patients, often associated with nasal spine calcifications.

Observation:

• This study reports the novel observation of calcinosis at the nasal spine in SSc patients with MERR transforming into cancellous bone-like tissue.
• Two SSc patients with MERR showed this bone replacement, visualized via cone-beam computed tomography (CBCT) and CT scans.
• One SSc patient with MERR and osteoporosis treatment did not exhibit this bone replacement phenomenon.

Findings:

• Calcinosis in the nasal spine of SSc patients with MERR can be replaced by cancellous bone-like tissue.
• Radiological imaging (CBCT, CT) is crucial for detecting this bone replacement in maxillofacial calcifications.
• Serum laboratory tests, including vitamin D levels, were within normal ranges for the observed patients.

Implications:

• This finding suggests a potential dynamic change in calcinosis within the maxillofacial region of SSc patients with MERR.
• Further research is warranted to understand the mechanisms and clinical significance of this bone replacement.
• Routine radiological examination of SSc patients with maxillofacial calcinosis is recommended to identify bone replacement.