Skeletal Radiol (2005) 34:35–41 DOI 10.1007/s00256-004-0830-6 ARTICLE Giovanni La Montagna Antonio Sodano Vittorio Capurro Domenico Malesci Gabriele Valentini The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study Received: 6 October 2003 Revised: 25 March 2004 Accepted: 18 June 2004 Published online: 17 September 2004  ISS 2004 G. La Montagna ( ) ) · D. Malesci · G. Valentini Dipartimento Medico-Chirurgico di Internistica, Clinica e Sperimentale “F Magrassi e A Lanzara”, Unità Operativa di Reumatologia, Seconda Università di Napoli, via S Pansini, 5, 80131 Naples, Italy e-mail: giovanni.lamontagna@unina2.it Fax: +39-081-5666737 A. Sodano · V. Capurro Dipartimento di Diagnostica per Immagini e Radioterapia, Università “Federico II”, via S Pansini, 5, 80131 Naples, Italy Abstract Objective: To assess the clinical and radiological features of systemic sclerosis (SSc) joint in- volvement in a prospective cross- sectional study. Design and patients: Seventy-six consecutive patients with SSc divided into clinical and sero- logical subsets were investigated. Clinical and radiological assessments of the hands and feet were carried out. Three radiological patterns of inflammatory, degenerative and fi- brotic changes were predefined. The Health Assessment Questionnaire (HAQ) disability index (DI) and in- dividual components of the HAQ-DI were also evaluated. Results: The highest impairments on the HAQ-DI (median 0.44; range 0–2.87) were detected in subdimensions such as hygiene, grip and activity compo- nents. Clinically articular involve- ment, arthralgia and finger contrac- tures were seen more frequently than arthritis, and a significantly higher prevalence of finger flexion was found in patients with diffuse cuta- neous SSc (P=0.03) compared with the other SSc subtypes. Radiologi- cally, distal interphalangeal joint space narrowing and flexion defor- mity indicating periarticular fibrosis were frequently detected. Juxta-ar- ticular osteoporosis, joint space nar- rowing and flexion contractures of the fingers were seen significantly more frequently in the hands. A sig- nificantly higher frequency of fibrotic pattern were found in the hands whereas a degenerative pattern was more frequent in the feet (P<0.05). Finally, significant correlations were detected between flexion contractures and a radiological fibrotic pattern (P<0.001), and the severity scores of peripheral vascular impairment (P=0.026) and skin (P=0.007). Conclusion: This cross-sectional prospective study confirms that an arthropathy is common in SSc pa- tients and shows that it is a major determinant of disability. A classifi- cation of radiological alterations into three specific patterns is proposed. Keywords Systemic sclerosis · Arthropathy · HAQ-DI · Clinical subsets · Serological subsets · Radiological patterns Introduction Systemic sclerosis (SSc) is a connective tissue disease characterized by deposition of collagen and other com- ponents of extracellular matrix in the skin and target in- ternal organs [1]. During the disease course, many pa- tients develop joint involvement which is manifest clini- cally as arthralgia and/or arthritis and/or flexion con- tractures, and radiologically as osteopenia, joint space narrowing, erosions and subluxation [2, 3]. Articular in- volvement in SSc could depend either on periarticular fibrosis or synovitis or even on an overlapping rheuma- toid arthritis [4], the prevalence of each type of joint in- volvement not having been accurately defined. We have