Radiological findings confirm that patients with systemic sclerosis (SSc) are susceptible to experiencing arthropathy, according to a study published in BMC Rheumatology. 

Many distinct radiological features of the hands and feet have been identified in SSc. However, there has yet to be a uniform classification of radiographic patterns to differentiate between disease severity, despite attempts to develop one in the past. 

The authors of this study sought to understand the extent of radiological hand and foot involvement in Iranian patients with SSc and to assess any association between these radiological findings and phenotype severity. The research team invited, via telephone call, all patients with SSc who were referred to the Sayyad Shirazi Medical Education Center and rheumatology clinics in Gorgan, Iran. Forty-three patients were recruited for the study. 

The participants all underwent a radiological assessment carried out by a radiologist based on a predefined set of radiographic findings based on reports from previous studies. Two blinded radiologists were asked to assess the radiographs on a computer, defining them on a scale from normal (0) to severe (3). The research team also took note of multisystemic manifestations of the disease, such as cardiac disease, pulmonary arterial hypertension, and gastrointestinal symptoms. 

Read more about SSc etiology 

The research team reported that they found “striking” levels of hand and foot involvement in SSc as determined via radiology. For example, hand acro-osteolysis was observed in 58.2% of the participants, while foot acro-osteolysis was seen in 46.5% of patients. In addition, the research team also reported common radiological features associated with SSc, such as hand calcinosis, marginal erosion, and hand juxta-articular osteoporosis. 

The authors also reported an association between hand joint space narrowing/hand acro-osteolysis and active skin involvement. Because skin and joint disease were often observed simultaneously, it cannot be excluded that cutaneous/subcutaneous manifestations of the disease affects joint anatomy. 

“In conclusion, this study confirms that arthropathy is prevalent in systemic sclerosis patients,” the authors wrote. 


Badiee F, Fatemi A, Zahedpasha R, et al. Hands and feet radiologic involvements in systemic sclerosisBMC Rheumatol. Published online May 20, 2023. doi:10.1186/s41927-023-00336-9