Imaging calcinosis in patients with systemic sclerosis by radiography, computerised tomography and magnetic resonance imaging

Hughes, Michael; Hodgson, Richard; Harris, James T.; Porter, Neil; Jackson, Sarah; Kirwadi, Anand; Manning, Joanne; Peytrignet, Sebastien; Herrick, Ariane L.

doi:10.1016/j.semarthrit.2019.03.001

Cited by 28 publications

(13 citation statements)

References 12 publications

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“…In the present study, DIP and PIP joint space narrowing, MCP joint erosions, and juxta-articular osteoporosis were observed to be the most common articular presentations, in line with the study carried out by La Montagna [5]. Subcutaneous calcinosis has been reported in 20%-40% of patients with SSc [17], which is similar to the SSc patients in the current study, 31.3% of whom had soft tissue calcinosis and 20.8% had para-articular calcifications.…”

Section: Discussionsupporting

confidence: 91%

Radiologic hand and wrist changes in systemic sclerosis: Associations with the disease duration, skin score and capillaroscopy

et al. 2019

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Patients with systemic sclerosis (SSc) have some musculoskeletal manifestations. The radiologic manifestations can be articular or non-articular. There is inconsistency in the correlation between clinical manifestations and radiologic changes; there are few reports on the correlation between them and capillaroscopy. A total of 81 patients with SSc who referred to a scleroderma clinic affiliated with Shiraz University of Medical Sciences, Iran, were evaluated in this cross-sectional, single-center study. Skin score test and capillaroscopy were performed, and an expert radiologist evaluated the posterior-anterior views of both hands and wrists. Data was analyzed using SPSS version 19. The participants consisted of 73 women and eight men aged 42 ± 2.6 years old, 60.5% of whom had limited scleroderma (lcSSc) and 39.5% had diffuse scleroderma (dcSSc). After 5 years, 91% of them had some radiologic changes, most of which were asymptomatic. The most common radiologic changes were non-articular (70.1%), including acro-osteolysis, subcutaneous and peri-articular calcinosis, and avascular necrosis. Flexion deformities and DIP joint space narrowing were seen more in patients with dcSSc. Resorption of the distal ulna and avascular necrosis was observed more in lcSSc. There was a correlation between radiologic changes and duration, but not with skin score. The most common capillaroscopic pattern in patients with radiologic change was late scleroderma pattern. Radiologic changes, which were mostly asymptomatic, were common in patients with SSc. The changes were different in patients with dcSSc and lcSSc and there were associations with duration and capillaroscopic patterns, but not with skin score.

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Section: Discussionsupporting

confidence: 91%

Radiologic hand and wrist changes in systemic sclerosis: Associations with the disease duration, skin score and capillaroscopy

et al. 2019

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“…Plain radiography is the recommended initial imaging for calcinosis, 71 given its low cost and comparable information to three-dimensional modalities. 72 The Scleroderma Clinical Trials Consortium (SCTC) developed and validated a radiographic scoring system for hand SSc-related calcinosis, which takes into account the area covered, density, number, and anatomic location of calcinosis lesions and provides an estimate of calcinosis burden. 73 Calcinosis can also be identified by ultrasound, various forms of computerized tomography (CT) imaging including dual-energy computed tomography (DECT)—a modern technique used for assessing monosodium urate deposits in soft tissue from patients with gout—magnetic resonance imaging (MRI) 74,75 and 18 F-NaF positron emission tomography PET/CT.…”

Section: Diagnosismentioning

confidence: 99%

Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis?

Valenzuela

Chung

2021

Journal of Scleroderma and Related Disorders

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Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is a manifestation of several autoimmune connective tissue diseases, most frequently with systemic sclerosis and juvenile dermatomyositis, followed by adult dermatomyositis. Autoimmune connective tissue disease–associated calcinosis is of the dystrophic subtype, which occurs at sites of damaged tissue in the setting of normal serum calcium and phosphate levels. In juvenile dermatomyositis, calcinosis is considered a marker of ongoing disease activity and possibly inadequate treatment, while in adult dermatomyositis, it is a hallmark of skin damage due to chronic rather than active disease. Calcinosis is associated with long disease duration in systemic sclerosis and dermatomyositis, anti-polymyositis/sclerosis autoantibodies in systemic sclerosis and NXP-2 and melanoma differentiation-associated gene 5 in dermatomyositis. Calcinosis in systemic sclerosis occurs most frequently in the hands, particularly the fingers, whereas in dermatomyositis, it affects mainly the trunk and extremities. The primary mineral component of calcinosis is hydroxyapatite in systemic sclerosis and carbonate apatite in dermatomyositis. Calcinosis in dermatomyositis and systemic sclerosis share some pathogenic mechanisms, but vascular hypoxia seems to play a more important role in systemic sclerosis, whereas the release of calcium from mitochondria in muscle cells damaged by myopathy may be a primary mechanism contributing to dermatomyositis-related calcinosis. Multiple treatment strategies for dermatomyositis and systemic sclerosis-related calcinosis have been used with variable results. Early aggressive treatment of underlying myositis in patients with dermatomyositis may improve long-term outcomes of calcinosis. A better understanding of the pathogenesis of calcinosis is needed to improve treatment options.

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“…A plain radiographic scoring system has been developed but requires further validation. [ 75 ] Three‐dimensional imaging with computed tomography (CT) has the advantage of measuring volume, [ 76 ] but is unlikely to be feasible for longitudinal studies and brings concerns about radiation exposure. In a study of 15 patients with SSc‐related hand calcinosis, radiographic area correlated highly with CT volume.…”

Section: Calcinosismentioning

confidence: 99%

“…In a study of 15 patients with SSc‐related hand calcinosis, radiographic area correlated highly with CT volume. [ 76 ] Ultrasound methods [ 77 ] deserve further study but are very operator‐dependent. As for skin and digital ulcers, novel PROMs are required [ 78 ] and will complement other methodologies. Can effective topical treatments be developed?…”

Section: Calcinosismentioning

confidence: 99%

Frontiers in translational systemic sclerosis research: A focus on the unmet 'cutaneous' clinical needs (Viewpoint)

Herrick

Shukla

Watson

2020

Experimental Dermatology

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Systemic sclerosis (SSc) is a multisystem connective tissue disease associated with high morbidity and mortality: its clinical features result from a combination of fibrosis and ischaemia. Clinicians and scientists have, understandably, tended to focus on its life-threatening internal organ complications [1] which include interstitial lung disease, pulmonary hypertension, and gastro-intestinal, cardiac and renal involvement ("scleroderma renal

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Imaging calcinosis in patients with systemic sclerosis by radiography, computerised tomography and magnetic resonance imaging

Cited by 28 publications

References 12 publications

Radiologic hand and wrist changes in systemic sclerosis: Associations with the disease duration, skin score and capillaroscopy

Radiologic hand and wrist changes in systemic sclerosis: Associations with the disease duration, skin score and capillaroscopy

Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis?

Frontiers in translational systemic sclerosis research: A focus on the unmet 'cutaneous' clinical needs (Viewpoint)

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