A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis

• Published in: Clinical and experimental rheumatology Vol. 32; no. 6 Suppl 86; pp. S - 68-74
• Main Authors: Bálint, Z, Farkas, H, Farkas, N, Minier, T, Kumánovics, G, Horváth, K, Solyom, A I, Czirják, L, Varjú, C
• Format: Journal Article
• Language: English
• Published: Italy 01.11.2014
• Subjects: Adult; Aged; Ankle Joint - physiopathology; Blood Sedimentation; C-Reactive Protein - metabolism; Cohort Studies; Contracture - etiology; Contracture - physiopathology; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Hand Joints - physiopathology; Hip Contracture - etiology; Hip Contracture - physiopathology; Humans; Knee Joint - physiopathology; Linear Models; Lung Diseases, Interstitial - etiology; Lung Diseases, Interstitial - physiopathology; Male; Middle Aged; Range of Motion, Articular - physiology; Scleroderma, Diffuse - complications; Scleroderma, Diffuse - metabolism; Scleroderma, Diffuse - physiopathology; Scleroderma, Limited - complications; Scleroderma, Limited - metabolism; Scleroderma, Limited - physiopathology; Scleroderma, Systemic - complications; Scleroderma, Systemic - metabolism; Scleroderma, Systemic - physiopathology; Shoulder Joint - physiopathology; Vital Capacity
• ISSN: 0392-856X

To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc). The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed. A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints. Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.