AB0459\u2005ARTICULAR INVOLVEMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS

Abstract

SSc (systemic sclerosis) is a connective tissue disease characterized by small vessel vasculopathy, production of autoantibodies, and fibroblast dysfunction leading to increased deposition of extracellular matrix in the skin and internal organs mainly. Therewithal, many SSc patients develop musculoskeletal symptoms during the course of their illness. Different rheumatic complaints such as arthralgia, arthritis, contractures, tendon friction rubs, calcinosis, and acroosteolysis can be seen as musculoskeletal symptoms in SSc patients [1].To provide an overview of the spectrum of articular involvement in SSc and determine the relationship between these involvements and Rheumatoid factor (RF) and Anti-cyclic citrullinated peptide (Anti-CCP) positivity and organ involvements.We performed a retrospective cohort study involving 232 SSc patients who were followed up in our department of rheumatology between 2000 and 2020 years. The patients were divided into two groups as limited and diffuse SSc. Age, gender, weight, height, smoking habits, duration of illness, follow-up duration, other systemic organ involvement, and radiographic findings were recorded. Diagnostic tests such as RF, Anti-CCP, ANA, ENA panel tests, direct radiographs were examined.The mean age of the patients was 59.9 ± 12.8 and 88.4% of them were women. 69.3% of patients were limited SSc. At any stage of the disease, 39.1% of all patients had arthralgia and 34.1% had arthritis. The arthritis rate was similar between the SSc groups (p = 0.396). RF and anti-CCP positivity rates were similar between the SSc groups. Although RF and anti-CCP positivity rates were higher in the patient group with arthritis, it was not statistically significant (respectively p=0.563, p=0.072). Interestingly, the lung involvement rate was higher in patients with arthritis (63.3% versus 46.4%) (p=0.015). Other clinical, demographic characteristics, laboratory, and radiographic findings of the patients are shown in Table 1.Articular involvement in SSc is a common clinical feature seen in one-third of patients regardless of the type of disease. Although RF and Anti-CCP positivity are more common in patients with arthritis, it was not statistically significant. Interestingly, arthritis is a more common manifestation in patients with lung involvement.[1]R. D. Sandler, M. Matucci-Cerinic, and M. Hughes, “Musculoskeletal hand involvement in systemic sclerosis,” Seminars in Arthritis and Rheumatism, vol. 50, no. 2. 2020, doi: 10.1016/j.semarthrit.2019.11.003.Table 1.Demographic and clinical characteristics of b/tsDMARDs patientsTable-1Limited SSc(n=161)Diffuse SSc(n=71)All patients(n=232)PAge (years) (Mean±SD)60.5 ± 12.758.6 ± 12.959.9 ± 12,80.295Disease duration (years) (Mean±SD)11.5 ± 6.612.4 ± 8.111.8 ± 7,10.384Weight (kg) (Mean±SD)68.2 ± 13.366.2 ± 15.667.6 ± 14.10.331BMI (kg/m2) (Mean±SD)27.6 ± 5.526.2 ± 6.127.1 ± 5.70.102Female, n (%)146 (90.7)59 (83.1205 (88.4)0.097Current and ex smoker, n (%)60 (37.2)18 (25.4)78 (33.6)0.077Digital ulcer, n (%)53 (32.9)34 (47.9)87 (37.5)0.03*Contracture on hand28 (17.4)28 (39.4)56 (24.1)<0,001*Arthralgia, n (%)63 (39.1)29 (31.5)92 (39.7)0.806Arthritis, n (%)52 (32.3)27 (38)79 (34.1)0.396Joint space narrowing on X-ray, n (%)44 (51.2)30 (63.8)74 (55.6)0.160Joint erosion on X-ray, n (%)17 (19.8)14 (29.8)31 (23.3)0.205Acroosteolysis on X-ray, n (%)9 (10.5)16 (34)25 (18.8)0.001*ANA positivity, n (%)155 (96.3)69 (97.2)224 (96.6)0.728Anti-Scl positivity, n (%)41 (28.7)48 (71.6)89 (42.4)<0.001*Anti-centromere positivity, n (%)65 (45.5)10 (14.9)75 (35.7)<0.001*RF positivity, n (%)27 (17.5)14 (20.6)41 (18.5)0.589Anti-CCP positivity, n (%)16 (12.7)7 (11.3)23 (12.2)0.782P*Independent Samples t Test, Pearson Chi-Square Test, BMI; Body mass index, ANA; Anti nuclear antibody,RF; Rheumatoid factor, Anti-CCP;Anti- Cyclic citrullinated peptideNone declared.