Ultrasonographic evaluation of hand and wrist joints in patients with systemic sclerosis

The objective of this investigation was to reveal abnormal musculoskeletal ultrasonographic (US) findings in the hand and wrist joints of systemic sclerosis (SSc) patients compared to healthy controls and to determine the severity of synovitis and tenosynovitis, as well as to disclose the demographic, clinical, and serologic characteristics of patients with SSc with synovitis.

The current study is a cross-sectional study comparing 50 SSc patients and 50 healthy controls between February and September 2023. Metacarpophalangeal (MCP), proximal interphalangeal (PIP), distal interphalangeal (DIP), and wrist joints were evaluated with US.

Synovitis (24 (48%) vs 6 (12%), p < .001), synovial hypertrophy (19 (38%) vs 1 (2%), p < .001), tenosynovitis (22 (44%) vs 5 (10%), p < .001), and calcinosis (7 (14%) vs 0, p = .012) were more common in SSc patients than in healthy controls. The presence of osteophytes was also more frequent in SSc patients but not statistically significant (36 (72%) vs 27 (54%), p = .062). The frequencies of moderate to severe synovitis and tenosynovitis were similar in the two groups, whereas mild synovitis (44% vs 12%, p < .001) and tenosynovitis (38% vs 8%, p < .001) were more common in SSc patients. The wrist was the most affected joint. Patients with synovitis had a higher mean age (p = .007) and erythrocyte sedimentation rate (ESR; p = .025). The presence of high c-reactive protein (CRP; p = .039) and hydroxychloroquine use (p = .024) were more common in these patients. There was no difference between the frequency of arthralgia in patients with and without synovitis.

Synovitis, tenosynovitis, and synovial hypertrophy seem to be quite common in SSc patients with or without arthralgia. Patients with synovitis are older, and acute phase markers may be higher in these patients.