Skleroderma olgularında ellerde oluşan kronik terminal falanks patolojilerinin direkt radyografi ile değerlendirilmesi

Amaç: Skleroderma olgularındaki terminal falanks değişikliklerini direkt radyografi ile ortaya koymayı amaçladık. Yöntem: Skleroderma tanısı ile izlenen ve yaş ortalaması 36.4 yıl olan (aralık, 22-48 yıl), hepsi kadın sekiz olgunun el-el bilek radyografileri akral (terminal falanks) patolojileri ve diğer el-el bileği değişiklikleri yönünden retrospektif olarak incelendi. Bulgular: Bilateral el-el bileği radyografilerinde olgularının 5’inde (%62.5) değişik derecelerde fleksiyon kontraktürleri ve 2’sinde (%25.0) pençe el-pençe el gelişim süreci, 6’sında (%75.0) interkarpal, karpometakarpal, metakarpofalangeal ve interfalangeal eklemlerde değişik lokalizasyonlarda ve derecelerde artritik ve dejeneratif değişiklikler, değişik derecelerde periartiküler osteoporoz izlendi. Olguların 2’sinde (%25.0), parmakların distalinde yumuşak doku kalsifikasyonları saptandı. Olguların 5’inde (%62,5) değişik derecelerde terminal falanks rezorpsiyonları (akroosteoliz), erozyon görüldü. Bu periosteal rezorpsiyon ve erozyonların, taftların palmar taraflarını daha çok etkilediği saptandı. Olguların 2’sinde (%25.0) akroosteoliz daha hafif ve sınırlı olup, 3’ünde (%37.5) terminal falankslarda belirgin sivrileşmeler şeklinde görüldü. Sonuç: Direkt radyografi, kronik skleroderma olgularında başta akroosteoliz olmak üzere terminal falanks patolojilerini göstermede yararlı bulunmuş olup bu konuda başvurulacak ilk görüntüleme yöntemi olmalıdır.

Anahtar Kelimeler:

Skleroderma, akroosteoliz, radiografi, elbilek

Evaluation of the chronic pathologies in terminal phalanges of scleroderma patients by plain radiographs

Purpose: We aimed to reveal terminal phalangeal changes in scleroderma patients by direct radiography. Materials and methods: Bilateral hand-wrists radiographs of eight women with a mean age of 36.4 years (range, 22-48 years) who were on follow-up with the diagnosis of scleroderma were retrospectively evaluated for acral (terminal phalanx) pathologies and other hand-wrist changes. ResultsOn bilateral hand-wrist radiographs, flexion contractures with different degrees in 62.5% (n=5/8) of cases, claw hand and claw hand development process in 25% (n=2/8) of cases, arthritic and degenerative changes in various localizations of the intercarpal , carpometacarpal, metacarpophalangeal and interphalangeal joints in 75% (n=6/8) of cases, various degrees of periarticular osteoporosis were observed. In 25% (n=2/8) of cases, soft tissue calcifications were detected distal to the fingers. Terminal phalanx resorption (acroosteolysis) and erosion were observed in 62.5% (n=2/8) cases. It has been determined that these periosteal resorption and erosions are more likely to affect the palmar sides of the taft. Acroosteolysis was milder and more limited in the two cases, and in the three cases, the terminal phalanges were seen as prominent cusps. Conclusion: Direct radiography has been found to be useful in showing terminal phalange pathologies, especially acroosteolysis in chronic scleroderma cases, and this should be the first imaging method to be applied.

Keywords:

Scleroderma, acro-osteolysis, radiography, wrist,

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