Arthritis in patients with systemic sclerosis

Background: Systemic sclerosis (SSc) is a connective tissue diseases characterised by excessive thickening of the dermis in addition to affection of internal organs. Many patients experience musculoskeletal symptoms, but arthritis is still considered to be a rare manifestation. Therefore, we analysed a cohort of SSc patients in our department and related the findings to published data. Methods: Clinical data on inpatients with SSc between February 2007 and February 2008 were analysed retrospectively for the presence of clinically overt and documented arthritis. In addition, X-rays of these patients were reassessed. A systematic literature search using PubMed was performed to find studies on arthritis in SSc patients; suitable studies were included in a meta-analysis based on the random-effect-model. The search terms were scleroderma, systemic sclerosis, arthritis, inflammatory joint disease, hand involvement, foot involvement and musculoskeletal findings in various combinations. Original articles not written in English and articles which were not dealing with arthritis in SSc patients were excluded from the study. We included articles in which the examined cohorts corresponds to the ACR- or LeRoy criteria for SSc and arthritis was diagnosed based on clinical and/or radiological data. All manuscripts were read and reviewed by two independent investigators. Results: In our cohort of 58 patients, 31% had signs of arthritis, 19% clinically and 26% radiologically. In a meta-analysis of 7 studies, a prevalence of 26% (95% CI [16.7, 36.1]) for radiologically detectable arthritis in SSc patients was observed. For clinical arthritis, the prevalence was calculated to be 23% (95% CI [14.9, 30.9]). Of interest, no difference in the occurrence of arthritis in diffuse and limited SSc was observed radiologically (OR=1.1, 95% CI [0.47, 2.57]) or clinically (OR=1.11, 95% CI [0.6, 2.05]). Conclusion: Arthritis is frequent manifestation of SSc. Its role in joint dysfunction has to be established in further studies. (C) 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.