Selective involvement of the first carpometacarpal joint in scleroderma

Area of Science:

• Rheumatology
• Orthopedics
• Radiology

Background:

• Scleroderma is a systemic autoimmune disease characterized by fibrosis of the skin and internal organs.
• Wrist involvement in scleroderma, particularly at the first carpometacarpal (CMC) joint, is not well-documented.
• Understanding specific joint manifestations is crucial for diagnosis and management.

Observation:

• Four female patients with scleroderma presented with selective involvement of the first CMC joint.
• Radiographic analysis revealed osseous erosion, radial subluxation of the metacarpal base, and intraarticular calcification in some patients.
• Perlarticular osseous erosions were also observed at adjacent wrist locations.

Findings:

• The first CMC joint is a distinct site of pathology in these scleroderma patients.
• Radiographic findings include bone erosion, metacarpal subluxation, and calcification.
• These changes resemble alterations seen in other connective tissue diseases.

Implications:

• The findings suggest a potential role for muscular and tendon imbalance in causing these specific bone and joint alterations.
• This distinctive wrist finding may serve as a diagnostic clue in patients with scleroderma.
• Further research is needed to elucidate the exact pathophysiology and clinical significance.