Demographic and clinical characteristics of spinal calcinosis in systemic sclerosis: Possible association with peripheral angiopathy

Abstract

The objective was to evaluate the demographic and clinical characteristics of systemic sclerosis (SSc) patients with spinal calcinosis. Paraspinal and intraspinal calcinosis was assessed blindly by orthopedic surgeons specializing in spinal diseases using chest high‐resolution computed tomography (CT) that was performed for the screening and prospecting of interstitial lung disease in 159 Japanese SSc patients. Among these patients, we identified 27 (17%) with spinal calcinosis, and the most common site was cervical level at 77.8% (21/27). The frequency of spinal calcinosis in the late stage was higher than in the early stage (44.4% vs 29.6%). Multiple calcinosis was identified in 18.5% (5/27). The frequency of paraspinal calcinosis only was 59.3%, intraspinal calcinosis only 18.5%, and both intraspinal and paraspinal calcinosis 22.2%. Among SSc patients, 4.4% (7/159) had CT‐based evidence of spinal cord compression. Among cases with spinal cord compression, only one had neurological symptoms, and surgical removal improved the symptoms. The other six SSc patients with spinal calcinosis (3.8% of 159) had no symptoms. Male sex (29.6%) and severe peripheral vasculopathy such as digital ulcers (55.6%) and acro‐osteolysis (33.3%) were significantly more frequent in the SSc patients with spinal calcinosis than in the SSc patients without spinal calcinosis (10.6%, 32.6% and 14.4%, respectively). Our results suggest that severe peripheral vasculopathy may be associated with the development of spinal calcinosis. Because SSc patients are prone to spinal calcinosis, when SSc patients claim symptoms such as pain, numbness and movement disorder of the extremities, spinal calcinosis is a complication that should be taken into consideration.

Relationship between calcifications and structural lesions on hand radiography and axial calcifications on CT-scan

“…As described by Avouac et al [ 13 ] and Johnstone et al [ 38 ] we confirmed the combination of calcinosis, acro-osteolysis and periarticular calcifications with the presence of digital ulcers, which is more related to vascular disease. As suggested by Motegi and al [ 39 ] the development of spinal calcinosis may be associated with peripheral vasculopathy. With respect to erosions and joint space narrowing, these lesions were mainly observed on DIP and PIP joints whereas the MCP joints were spared, a classical finding usually observed in digital osteoarthritis and psoriatic arthritis.…”

Systemic sclerosis-associated compressive cervical calcinosis: intersection of degenerative spine instability, lesional spinal cord compression, and traumatic spinal cord injury. Illustrative case

“…10 , 21 Spinal cord compression in scleroderma-associated calcinosis is rare. Motegi et al 8 report that of 159 patients with systemic scleroderma, 27 (17%) had spinal calcinosis. Of those with spinal calcinosis, 7 of 27 (25.9%) had spinal cord compression from calcinosis, which represents 4.4% of patients with systemic scleroderma who have spinal cord compression.…”

“…Of those with spinal calcinosis, 7 of 27 (25.9%) had spinal cord compression from calcinosis, which represents 4.4% of patients with systemic scleroderma who have spinal cord compression. 8 …”

“…Of those with spinal calcinosis, 7 of 27 (25.9%) had spinal cord compression from calcinosis, which represents 4.4% of patients with systemic scleroderma who have spinal cord compression. 8 Spinal calcinosis in patients with scleroderma remains an uncommon, although potentially neurologically devastating entity. Therefore, we conducted a review of the literature of cervical spine calcinosis in patients with scleroderma/systemic sclerosis over the last 20 years (since 2000).…”

“…6,7 A somewhat uncommon presentation of systemic sclerosis is calcinosis of the spine whereby insoluble calcium salts are deposited into the paraspinous tissues, joints, and more rarely, the epidural tissues of the spine. [7][8][9][10][11][12][13] When this abnormal calcified tissue forms as a solid mass, it can structurally behave as a tumor and therefore is termed tumoral calcinosis. 14 This abnormal calcified tissue acts as a mass adjacent to the spinal cord and destabilizes the bony spine, thereby setting up the perfect scenario for spinal cord injury.…”