Bojana Stamenković, Sonja Stojanović, Valentina Živković, Dragan Đorđević, Mila Bojanović, Hristina Kocić, Vanja Đurić, Aleksandra Stanković

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Musculoskeletal manifestations (MSM) frequently occur in systemic sclerosis (SSc) and imply a variety of rheumatic symptoms and clinical features, from arthralgia to arthritis, contractures, tendon friction rubs, tenosynovitis, myalgia, muscle tenderness,  and myositis. The objective of the study was to determine the prevalence of joint manifestations in clinical findings, as well as frequency and type of radiographic changes in 56 patients with the limited and diffuse form of SSc; to define the correlation between musculoskeletal hand changes in SSc and specific antibodies (antinuclear antibodies- ANA), as well as with antibodies specific for particular forms of SSc (anti-topoisomerase-1 antibodies- ATA, anticentromere antibodies- ACA); and to test the correlation between specific cardiopulmonary manifestations in SSc, and frequency and type of musculoskeletal changes. The obtained results indicated a high frequency of joint manifestations in SSc, which were estimated by clinical and radiographic examinations. Joint involvement in SSc was underestimated in clinical trials, as it occurred more frequently than expected. Radiographic hand findings in tested SSc patients indicated the presence of arthritis, erosions, joint space narrowing, radiological demineralization, acro-osteolysis, flexion contractures, and calcinosis. Hand involvement was an important cause of morbidity, which seriously affected the quality of life in patients with SSc. Various forms of joint and bone involvements could represent the base for introducing an innovative approach to treating musculoskeletal hand damage in SSc.


joint involvement, radiographic changes in hand, systemic sclerosis

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Black CM, Matucci-Cerinic M, Guillevin L. Progress in systemic sclerosis: a 10-year perspective. Rheumatology 2009; 48(3):iii1–iii2.

LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): Classification, subsets and pathogenesis. J Rheumatol 1988; 15(2):202–205.

Damjanov N. Sistemska skleroza: klinički oblici i rana dijagnoza bolesti. Acta Rheum Bel¬grad 2005; 35(2):131–135.

Distler JHW, Gaz S, Distler O. Angiogenesis and vasculogenesis in systemic sclerosis. Rheu¬ma¬tology 2006; 45(3):iii26–iii27.

Distler JHW, Allanore Y, Avouac J, et al. EULAR Scleroderma Trials and Research group statement and recommendations on endothelial precursor cells. Ann Rheum Dis 2009; 68:163–168.

Varga J, Trojanowska M, Kuwana M. Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord 2017; 2(3):137–152.

Koenig M, Dieude M, Senecal JL. Predictive value of antinuclear autoantibodies: The lessons of the systemic sclerosis autoantibodies. Autoimmun Rev 2008; 7(8):588–593.

Kuwana M. Circulating anti-nuclear antibodies in systemic sclerosis: utility in diagnosis and disease subsetting. J Nippon Med Sch 2017; 84(2):56–63.

Kowal-Bielecka O, Kuryliszyn-Moskal A. Twardzina układowa. Systemic sclerosis. Reumatologia 2016; Suppl 1:51–55.

Barsotti S, Bellando Randone S, Guiducci, S, et al. Systemic sclerosis: a critical digest of the recent literature. Clin Exp Rheumatol 2014; 32: S194–S205.

Avouac J, Walker UA, Hachulla E. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis 2016; 75:103–109.

Morrisroe KB, Nikpour M, Proudman SM. Musculoskeletal Manifestations of Systemic Sclerosis. Rheum Dis Clin N Am 2015; 41:507–518.

Stamenkovic B. Promenenašakama u sistemskoj sklerozi-korelacija sa kliničkim i imunskim profilom. Doktorska disertacija, Medicinski fakultet, Univerzitet u Nišu, 2012.

Avouac J, Guerini H, Wipff J, et al. Radiological hand involvement in systemic sclerosis. Ann Rheum Dis 2006; 65: 1088–1092.

Avouac J, Mogavero G, Guerini H, et al. Predictive factors of hand radiographic lesions in systemic sclerosis: a prospective study. Ann Rheum Dis 2011; 70(4):630–633, doi: 10.1136/ard.2010.134304.

Johnstone EM, Hutchinson CE, Vail A, et al. Acro-osteolysis in systemic sclerosis is associated with digital ischaemia and severe calcinosis. Rheumatology (Oxford) 2012; 51:2234–2238.

van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013; 65(11):2737–2747. doi: 10.1002/art.38098.

Lammi MR, Saketkoo LA, Gordon JK, et al. Clinical characteristics and survival of systemic sclerosis patients with pulmonary hypertension and elevated wedge pressure: Observationsfrom the PHAROS cohort. Respirology 2017; 22:1386–1392.

Young A, Namas R, Dodge C, Khanna D. Hand Impairment in Systemic Sclerosis: Various Manifestations and Currently Available Treatment.Curr Treat Options in Rheum 2016; 2:252–269

Avouac J, Walker U, Tyndall A, and EUSTAR group. Characteristics of Joint Involvement and Relationships with Systemic Inflammation in Systemic Sclerosis: Results from the EULAR Scleroderma Trial and Research Group (EUSTAR) Database. J Rheum 2010; 37:7.

Allali F, Tahiri L, Senjari A, et al. Erosive arthropathy in systemic sclerosis. BMC Public Health 2007; 7:260

Admou B, Arji N, Seghrouchni M, et al. Low prevalence of anti centromere antibodies in scleroderma in Morrocco (about 272 cases). Ann Biol Clin (Paris) 2007; 65(3):291–297.

Boutry N, Hachulla E, Zanetti-Musielak C, et al. Imaging features of musculoskeletal invol¬vement in systemic sclerosis. Eur Radiol 2007; 17:1172–1180

Radic M, Martinovic Kaliterna D, Ljutic D. The level of anti-topoisomerase I antibodies highly correlates with metacarpophalangeal and proximal interphalangeal joints flexion contractures in patients with systemic sclerosis. Clin Exp Rheumatol 2006; 24(4):407–512

La Montagna G, Sodano A, Capurro V, et al. The arthropathy of systemic sclerosis: a 12 mon¬th prospective clinical and imaging study. Skeletal Radiol 2005; 34(1):35–41.

Baron M, Lee P, Keystone EC. The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 1982; 41(2):147–152

Smolen JS, Van der Heijde DM, Aletaha D, et al. Progression of radiographic joint damage in rheumatoid arthritis: independence of erosions and joint space narrowing. Ann Rheum Dis 2009; 68:1535–1340.

Syversen SW, Golli GL, van der Heijde D, et al. Prediction of radiographic progression in rheu¬matoid arthritis and the role of antibodies against mutated citrullinated vimentin: results from a 10-year prospective study. Ann Rheum Dis 2010; 69:345–351.



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