Evaluation of the chronic pathologies in terminal phalanges of scleroderma patients by plain radiographs

Öz

Purpose: We aimed to reveal terminal phalangeal changes in scleroderma patients by direct radiography.

 

Materials and methods: Bilateral hand-wrists radiographs of eight women with a mean age of 36.4 years (range, 22-48 years) who were on follow-up with the diagnosis of scleroderma were retrospectively evaluated for acral (terminal phalanx) pathologies and other hand-wrist changes.

 

Results

On bilateral hand-wrist radiographs, flexion contractures with different degrees in 62.5% (n=5/8) of cases,  claw hand and claw hand development process in 25% (n=2/8) of cases, arthritic and degenerative changes in various localizations of the  intercarpal , carpometacarpal, metacarpophalangeal and interphalangeal joints in  75% (n=6/8) of cases, various degrees of periarticular osteoporosis were observed. In 25% (n=2/8) of cases, soft tissue calcifications were detected distal to the fingers. Terminal phalanx resorption (acroosteolysis) and erosion were observed in 62.5% (n=2/8) cases. It has been determined that these periosteal resorption and erosions are more likely to affect the palmar sides of the taft. Acroosteolysis was milder and more limited in the two cases, and in the three cases, the terminal phalanges were seen as prominent cusps.

 

Conclusion: Direct radiography has been found to be useful in showing terminal phalange pathologies, especially acroosteolysis in chronic scleroderma cases, and this should be the first imaging method to be applied.

Anahtar Kelimeler

• Scleroderma,acro-osteolysis,radiography,wrist

Skleroderma olgularında ellerde oluşan kronik terminal falanks patolojilerinin direkt radyografi ile değerlendirilmesi

Öz

Amaç: Skleroderma olgularındaki terminal falanks değişikliklerini direkt radyografi ile ortaya koymayı amaçladık. Yöntem: Skleroderma tanısı ile izlenen ve yaş ortalaması 36.4 yıl olan (aralık, 22-48 yıl), hepsi kadın sekiz olgunun el-el bilek radyografileri akral (terminal falanks) patolojileri ve diğer el-el bileği değişiklikleri yönünden retrospektif olarak incelendi. Bulgular: Bilateral el-el bileği radyografilerinde olgularının 5’inde (%62.5) değişik derecelerde fleksiyon kontraktürleri ve 2’sinde (%25.0) pençe el-pençe el gelişim süreci, 6’sında (%75.0) interkarpal, karpometakarpal, metakarpofalangeal ve interfalangeal eklemlerde değişik lokalizasyonlarda ve derecelerde artritik ve dejeneratif değişiklikler, değişik derecelerde periartiküler osteoporoz izlendi. Olguların 2’sinde (%25.0), parmakların distalinde yumuşak doku kalsifikasyonları saptandı. Olguların 5’inde (%62,5) değişik derecelerde terminal falanks rezorpsiyonları (akroosteoliz), erozyon görüldü. Bu periosteal rezorpsiyon ve erozyonların, taftların palmar taraflarını daha çok etkilediği saptandı.  Olguların 2’sinde (%25.0) akroosteoliz daha hafif ve sınırlı olup, 3’ünde  (%37.5) terminal falankslarda belirgin sivrileşmeler şeklinde görüldü. Sonuç: Direkt radyografi, kronik skleroderma olgularında başta akroosteoliz olmak üzere terminal falanks patolojilerini göstermede yararlı bulunmuş olup bu konuda başvurulacak ilk görüntüleme yöntemi olmalıdır.

Anahtar Kelimeler

• Skleroderma,akroosteoliz,radiografi,elbilek

Kaynakça

1. 1. Burgener FA, Kormano M. Differential diagnosis in conventional radiology. 2nd ed. New York: Thieme Medical Publishers, Inc. 1991;87,270,274-281.2. Lu H, Chen Q, Yang H, Shen H, Liu Y. Enchondroma in the distal phalanx of the finger An observational study of 34 cases in a single institution Medicine (Baltimore). 2016 Sep; 95(38): e4966.3. Zadek I, Cohen HG. Epidermoid cyst of the terminal phalanx of a finger; with a review of the literature. Am J Surg. 1953 Jun;85(6):771–774.4. Van Geertruyden J, Lorea P, Goldschmidt D, de Fontaine S, Schuind F, Kinnen L, et al. Glomus tumours of the hand. A retrospective study of 51 cases. J Hand Surg Br. 1996;21:257–2605. Zisman DA, Shorr AF, Lynch JP 3rd. Sarcoidosis involving the musculoskeletal system. Semin Respir Crit Care Med. 2002;23(6):555-70.6. Holt JF, Dickerson WW. The osseous lesions of tuberous sclerosis. Radiology. 1952 Jan;58(1):1-8. 7. McKay P, Formby P, Dickens, JF, Gibson M. Osteomyelitis and septic arthritis of the hand and wrist Current Orthopaedic Practice 2010;21: 542-5508. Leeson MC, Lowry L, McCue RW. Aneurysmal bone cyst of the distal thumb phalanx. A case report and review of the literature. Orthopedics 1988 Apr;11(4):601-604.9. Flynn CJ, Danjoux C, Wong J, Christakis M, Rubenstein J, Yee A, Yip D, Chow E. Two cases of acrometastasis to the hands and review of the literature Curr Oncol. 2008 Oct;15(5):51-8.10. Ory PA, Gladman DD, Mease PJ. Psoriatic arthritis and imaging. Ann Rheum Dis 2005;64:55–57.11. Borys D, Canter R, James MA. Monostotic fibrous dysplasia of the distal phalanx: case report J Hand Surg Am. 2010 Aug;35(8):1294-1296.12. Botou A, Bangeas A, Alexiou I, Sakkas L. Acro-osteolysis. Clin Rheumatol. 2017 Jan;36(1):9-14. 13. Demir K, Acartürk G. Skleroderma ve Özofagus Turkiye Klinikleri J Gen Surg-Special Topics 2012;5(3):112-11514. Bassett LW, Blocka KL, Furst DE, Clements PJ, Gold RH. Skeletal findings in progressive systemic sclerosis (scleroderma) American Journal of Rentgenology 1981;136:1121-1126.15. Schanz S, Henes J, Ulmer A, Kötter I, Fierlbeck G, Claussen CD, Horger M. Magnetic resonance imaging findings in patients with systemic scleroderma and musculoskeletal symptoms. Radiol. 2013 Jan;23(1):212-221.16. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980 May;23(5):581-590.17. Mcdonald DK, Parman L, Speights VO. Best cases from the AFIP: primary hyperparathyroidism due to parathyroid adenoma. Radiographics 2005 May-Jun;25(3):829-834. 18. Martel W, Stuck KJ, Dworin AM et-al. Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. Am J Roentgenol 1980;134(1):125-135.19. Ferreira I.R., Domingues V.S. Acro-osteolysis Lancet 2012: 380, 91620. Greenspan A. Orthopedic radiology. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2000;480-483.21. Dahnert W. Radiology Review Manual. 4th ed. Baltimore: Williams and Wilkins, 1999;16,60,141,711.22. Avouac J, Guerini H, Wipff J et-al. Radiological hand involvement in systemic sclerosis. Ann. Rheum. Dis. 2006;65(8):1088-1092. 23. Godin E, Capesius P, Kempf F. Acro-osteosclerosis in the course of sarcoidosis. J Radiol Electrol Med Nucl 1977;58(2):115-118.24. Lewkonia RM, Pope FM. Joint contractures and acroosteolysis in Ehlers-Danlos syndrome type IV. J Rheumatol 1985;12(1):140-144.25. Austin CB, Young JWR, Park HJ, Needleman BW, Handwerger BS, Rosenbaum RC. Massive acroosteolysis in adult T-cell leukemia/ lymphoma. Radiology 1987;164:787-789.26. Leventhal LJ, Straka PC, Schumacher HR Jr. Jaccoud artropathy and acroosteolysis in KID syndrome. J Rheumatol 1989;16:1274-1277.27. Udell J, Schumacher HR Jr, Kaplan F, Fallon MD. Idiopathic familial acroosteolysis: histomorphometric study of bone and literature review of the Hajdu-Cheney syndrome. Arthritis Rheum 1986;29:1032-1038.28. Tuncel E. Klinik Radyoloji. 1st ed. Bursa:Güneş ve Nobel Tıp Kitapevleri, 1994;491.29. Johnstone EM1, Hutchinson CE, Vail A, Chevance A, Herrick AL. Acro-osteolysis in systemic sclerosis is associated with digital ischaemia and severe calcinosis. Rheumatology (Oxford) 2012 Dec;51(12):2234-8.