Tendons, joints, and bone

Abstract

While tethering of the skin is the clinical hallmark of SSc, many patients may develop musculoskeletal symptoms as an early sign of the disease or during the course of their illness. Manifestations may include varying degrees of rheumatic complaints ranging from symptoms of carpal tunnel syndrome, arthralgias to frank arthritis, or uncomfortable bony lesions. Musculoskeletal involvement strongly contributes to disability and impaired quality of life in SSc, reducing the performance of everyday occupation [1-5]. Indeed, several cross-sectional studies highlight the major impact of musculoskeletal involvement on the quality of life in SSc. One report investigated the relationship between patient beliefs, symptom report, and clinical/demographic variables. This study included a total of 49 patients (7 male, 42 female) who underwent clinical examination and completed the Revised Illness Perception Questionnaire. The symptoms patients most frequently associated with SSc were stiff joints (79%), pain (75%), and fatigue (75%), all secondary to musculoskeletal involvement. More than 96% of patients believed that their condition would be chronic and 78% believed that the condition had serious consequences on their lives. Patients with diffuse cutaneous SSc reported more significant consequences of the condition and less personal control of their SSc compared with patients with limited cutaneous disease [6]. Another study focused on the ability to perform daily activities and analyzed in detail hand function. Data from 30 patients showed that dexterity was on average reduced to 68-80%, and grip force to 46-65% compared with values for healthy persons. Finger flexion and extension were the most impaired aspects of hand mobility. Activities requiring hand and arm function were harder to perform than activities depending on lower limb function. Stiffness, grip force, and dexterity had the highest strength of association with difficulties of daily living activities after the impact of Raynaud's phenomenon was considered. [7]. A study investigating the impairment of hand function suggested that scleroderma-related difficulty was similar or even higher than in rheumatoid arthritis or digital osteoarthritis. The authors showed the reliability and validity of Duruöz Hand Index in SSc and found a mean total score of 21.10 ± 19.25 (0-66), whereas mean scores of about 17 or 19 have been reported in series of patients with RA or OA [3]. The objective of this chapter is to provide an overview of the spectrum of tendon, joint, bone, and soft tissue involvement in SSc to further underscore the multisystem nature of this condition and to review the different therapeutic approaches of these lesions.