Hand and Wrist Involvement in Systemic Sclerosis: US Features

Abstract

US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article.

Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study

“…FPBF evaluated by PDUS has already proven to be pathologic in SSc in contrast to healthy controls . Our study is the first showing pathologic FPBF as a predictive risk factor of new ischemic DUs and as a parameter associated with a history of multiple episodes of DU.…”

“…Predictive scores based on clinical features , capillaroscopic findings , and biologic markers have recently been developed to identify patients with a high risk of new occurrence of DU. Only 1 study has tested the predictive performances of power Doppler ultrasonography (PDUS) for SSc DUs .…”

“…Therefore, our aim was to evaluate prospectively the relevance of PDUS as a predictive tool of new DUs in a cohort of unselected SSc patients. Finger pulp blood flow (FPBF), reduction , and ulnar artery occlusion (UAO) assessed by PDUS were compared to the history of DUs and to the onset of new ischemic DUs during a followup period of 1 year.…”

Acroosteolysis in systemic sclerosis: An insight into hypoxia-related pathogenesis

“…Osteolysis generally starts on the palmar aspect of the tuft, leading to sharpening of the distal phalanx and, in rare cases, the middle phalanx (5). Ultrasonography is similar to radiography in the detection of AO, revealing interruption of the cortical contours and increased vascularization at bone resorption sites (8). Rarely resorption may affect other bones, such as the mandible, distal radius and ulna, distal clavicle, ribs or even cervical vertebrae (9).…”

“…The pathogenesis of AO in SSc is not well understood; presumed mechanisms include a reduction of vascular supply due to digital occlusive vasculopathy and later due to external compression from skin tightening, impaired angiogenesis due to defective sprouting following hand microtrauma, nerve alteration due to compressive neuropathy in the carpal, ulnar or cubital tunnel, and occult hyperparathyroidism resulting from vitamin D deficiency (7)(8)(9)(10). However, the main contributors to AO in SSc appear to be vascular impairment, as well as an imbalance in bone remodeling favoring resorption.…”