{
  "abstract": "Introduction Acro-osteolysis occurs in ~20-25% of patients with systemic sclerosis (SSc). Although pathogenesis remains currently incompletely understood, it is easily assessed utilising hand radiographs.Our objectives were to:Investigate the distribution and severity of radiographically assessed hand acro-osteolysis.Examine change in acro-osteolysis scoring over time.Material and Methods Patients with 2 or more complete hand radiographs from different time points were included. The final image set contained 180 images from 90 patients.Radiographs were presented to a single (blinded) observer for assessment:180 images presented in a random order. Each of ten fingers/digits was scored according to Johnstone1: 0 (normal terminal phalanges) to 4 (complete resorption of the terminal tuft). The total (sum) over all digits was calculated for each image.90 image pairs were presented with time order randomised, and assessed based on the question ‘is the acro-osteolysis status of the right-hand image more or less severe than the left-hand image?’: 5-point ordinal scale (+2 ‘much more severe’ to -2 ‘much less severe’).We used the original/raw data, with missing values, and used descriptive statistics to describe these.Results Of 90 included patients, median (IQR) age was 53 (44-63) years (female 83%). Disease duration (from first non-Raynaud’s manifestation) was 3.7 (1.0-8.5) years; 73% had limited cutaneous SSc. ANA positivity was 81% (anticentromere 36%; anti-Scl-70 20%, anti-RNA polymerase III 9%, anti-RNP 9%, anti-PMScl 1%). Two-thirds (66%) had a history of digital ulcers (66%) and around half had calcinosis (clinical: 48%, radiographic: 58%).No score could be given in 102 of 1800 digits (amputation: 17%, obscured digit: 83%). The mean (SD) total finger score was 4.16 (8.80). The index and middle fingers scored highest, thumbs were intermediate, and ring/little fingers scored lowest. Left- and right-hand scores were comparable.Only images with at least 3 classifiable digits per hand from initial assessment were further analysed pair-wise, resulting in removal of 9/90 pairs (10%). Breakdown of change within image pairs (later image compared to baseline): ‘much more severe’ (9/81, 11%): ‘more severe’ (16/81, 20%), ‘the same’ (53/81, 65%), ‘less severe’ (3/81, 4%), and ‘much less severe’ (0/81, 0%). The mean (SD) change score over all pairs of images was 0.38 (0.73), suggestive of a slight worsening of acro-osteolysis over time.Conclusions Acro-osteolysis can be objectively measured by hand radiographs in patients with SSc and is often progressive over time.Reference Johnstone, et al. PMID: 22923763.",
  "authors": [
    {
      "affiliations": [
        "Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK"
      ],
      "name": "Michael Hughes"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Graham Dinsdale"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Aayushi Agnihotri"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Joanne Manning"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Muditha Samaranayaka"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Jonathan Harris"
    },
    {
      "affiliations": [
        "Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK",
        "Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"
      ],
      "name": "Ariane Herrick."
    }
  ],
  "title": "P.386 Radiographic hand assessment of acro-osteolysis in systemic sclerosis provides novel insights into pathogenesis and evolution of disease burden over time",
  "uid": "c3676311-cd8c-5fdd-ac52-385063142f54"
}