Tendons, Joints, and Bone

Musculoskeletal (MSK) involvement and symptoms are frequently reported in patients with systemic sclerosis (SSc) and may occur in the early stages of disease and/or at any time during its course. Manifestations range from carpal tunnel syndrome, tendon involvement, and inflammatory polyarthralgia to frank inflammatory arthritis and bony lesions. MSK involvement has been shown to limit daily occupational activities, strongly contributing to impaired quality of life and work disability in SSc, a major burden even in early disease. Joint pain has been reported as the most common type of pain in patients with scleroderma, significantly contributing to depression. MSK ultrasound has demonstrated that inflammatory synovitis and fibrotic tendon involvement are much more frequent than reported by clinical examination. Similarly, the impairment of hand function in SSc was found to be similar or even higher than in patients with rheumatoid arthritis or digital osteoarthritis. Finger flexion and extension were reported as the most severe impairment of hand mobility. Moreover, the presence of tendon friction rubs and arthritis are key predictors of overall disease progression and poor prognosis in scleroderma patients. Unfortunately, there are currently no effective medical treatments for manifestations such as calcinosis and hand acro-osteolysis. Systemic and local glucocorticoids, methotrexate, and some biologics are commonly employed in the treatment of articular and tendon involvement in SSc. The development of reliable SSc-specific MSK outcome measures is needed that can be applied in future randomized controlled trial. This will identify effective therapies that can address MSK manifestations of SSc.