Clinical Investigation
Decreased Femoral Cartilage Thickness in Patients With Systemic Sclerosis

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Abstract

Background

Systemic sclerosis (SSc), or scleroderma, is a severe connective tissue disease. Although musculoskeletal involvement is frequent and causes significant functional disability in patients with SSc, articular cartilage thickness has not been previously investigated. The aim of this study was to compare the femoral cartilage thickness (FCT) in patients with SSc with that of controls who were matched for age, body mass index and osteoarthritis prevalence.

Methods

The thickness of femoral articular cartilage was measured by ultrasonography in patients and controls. Three midpoint measurements were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area and medial femoral condyle (MFC).

Results

Forty female patients with SSc and 85 female controls were included. In patients with SSc, 18 (45.0%) had diffuse SSc, 18 (45.0%) had limited SSc, 1 (2.5%) had overlap (polymyositis) and 3 (7.5%) had SSc sine scleroderma. The mean FCT measurements of patients with SSc at MFC of the right and left knees (1.86 and 1.84 mm, respectively) and LFC of the left knee (1.93 mm) were statistically lower than in the controls (right and left MFC, 2.23 and 2.25 mm, respectively, P < 0.0001, and left LFC 2.15 mm, P = 0.026).

Conclusions

Patients with SSc had thinner femoral cartilage compared with controls. The underlying possible mechanisms of thin FCT may be multifactorial, and there may be many influencing factors like immune activation, vasculopathy, oxidative stress and synovial fibrosis or markers of cartilage degradation. The possible factors influencing the change in cartilage thickness or metabolism in patients with SSc require further research.

Section snippets

MATERIALS AND METHODS

Patients were recruited from our SSc cohort, which consists of consecutively included patients who were diagnosed and followed up at our rheumatology outpatient clinic. All the patients in this cohort met the criteria for the classification of SSc13 and were clinically classified as having diffuse (dSSc) or limited (lSSc) according to the LeRoy clinical criteria.14 In this particular study, patients with a history of intra-articular injections or any surgery of the knee or who did not have full

RESULTS

Forty patients with SSc and 85 controls were included. All the participants were women and 15 (37.5%) in the SSc group and 23 (27.06%) in the control group met the ACR criteria for the classification of knee OA15 (χ2, P > 0.05), and all the osteoarthritic knees in both groups had Kellgren-Lawrence score I or II. Twenty-two (55.0%) patients with SSc and 58 (68.24%) controls were postmenopausal (χ2, P > 0.05). Thirty-eight of the patients with SSc (95.0%) and 71 of the controls were nonsmokers

DISCUSSION

This is the first study to assess FCT in patients with SSc. In this cross-sectional study, we found that patients with SSc had thinner cartilage at the medial condyle of both knees and lateral condyle of the left knee compared with controls matched with age, BMI and OA prevalence.

Musculoskeletal manifestations of SSc are frequent and can be a major cause of morbidity and disability in patients with SSc.2., 6., 7. However, the relationship between SSc and changes in cartilage thickness or

CONCLUSIONS

This study clearly shows that patients with SSc have thinner femoral cartilage compared with controls matched with age, BMI and OA prevalence. Because of the complex pathophysiology of cartilage metabolism, as well as the complex pathogenesis of SSc, it is not possible to make clear-cut conclusions. In this study, we determined that patients with SSc have decreased FCT. Biomarkers for cartilage degradation and regeneration may be viable options for future research studies to further investigate

REFERENCES (41)

  • S. Omoto et al.

    Expression and localization of connective tissue growth factor (CTGF/Hcs24/CCN2) in osteoarthritic cartilage

    Osteoarthritis Cartilage

    (2004)
  • M. Hinchcliff et al.

    Systemic sclerosis/scleroderma: a treatable multisystem disease

    Am Fam Physician

    (2008)
  • M. Baron et al.

    The articular manifestations of progressive systemic sclerosis (scleroderma)

    Ann Rheum Dis

    (1982)
  • K.L. Blocka et al.

    The arthropathy of advanced progressive systemic sclerosis. A radiographic survey

    Arthritis Rheum

    (1981)
  • J. Avouac et al.

    Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database

    J Rheumatol

    (2010)
  • M. Inci et al.

    Increased femoral cartilage thickness in patients with Klinefelter syndrome

    Am J Mens Health

    (2013)
  • L. Riente et al.

    Ultrasound imaging for the rheumatologist XIV. Ultrasound imaging in connective tissue diseases

    Clin Exp Rheumatol

    (2008)
  • E. Naredo et al.

    Ultrasound validity in the measurement of knee cartilage thickness

    Ann Rheum Dis

    (2009)
  • A. Kaya et al.

    Ultrasonographic evaluation of the femoral cartilage thickness in patients with systemic lupus erythematosus

    Rheumatol Int

    (2013)

  • 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)

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    The authors have no financial or other conflicts of interest to disclose.

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