Only 14 pages are availabe for public view
cleroderma or systemic sclerosis (SSc) is a rare chronic disorder characterized by diffuse fibrosis of the skin and internal organs. It is an acquired rheumatic disease of unknown cause (Wendahl et al., 2019).
The hallmark of the disease is thickening and tightness of the skin and of subcutaneous tissue. SSc may be confined to the skin (localised) or it may be generalised (systemic sclerosis). In the generalised form, involvement virtually of any organ systems can occur, most importantly the skin, blood vessels, lungs, kidneys, gastrointestinal tract, and the heart (Pelechas et al., 2019).
Our study aimed to study levels of vitamin D in relation to the femoral cartilage thickness (FCT) in patients with SSc and to analyze the associations between the (FCT), vitamin D levels and SSc- disease activity.
Our study was cross-sectional study which included 40 adult systemic sclerosis patients diagnosed according to ACR/EULAR (2013) classification criteria of systemic sclerosis (Van den Hoogen et al., 2013).
All the patients were subjected to: Full history taking, clinical examination including musculoskeletal examination and laboratory investigations. Serum 25(OH) D was measured to all studied patients and femoral cartilage thickness was assessed by ultrasound.
Studied patients were categorized into two groups according to vitamin D sufficiency; group I with vitamin D level > 30 ng/ml which included 14 patients, and group II with vitamin D level < 30 ng/ml which included 26 patients.
In our study; the most common clinical manifestation was Raynaud’s phenomenon (95%), followed by skin tightness (87.5%), proximal muscle weakness (87.5%), gastritis (65%) (this was the most common GIT manifestation), weight loss (60%), GERD (55%), dysphagia (50%), pulmonary hypertension (50%), iterstitial lung fibrosis (47.5%), digital tip scarring (40%), digital tip ulcers (30%), symptoms of heart failure (27.5%), arthralgia or arthritis (22.5%) and finally calcinosis, digital gangrene and symptoms of ischemic heart disease (5% each) then GIT bleeding and arrhythmia (2.5% each).
Proximal muscle weakness were graded as follows; (50%) were grade 4, followed by grade 3 (32.5%), grade 5 (12.5%) then grades 1 and 2 (2.5%) each.
The modified Rodnan skin score in this study ranged from 0 to 30 with mean±SD of 8.25±8.13 and the most affected area was fingers (72.5%).
As regard laboratory studies, we found that; (65%) of studied patients were ANA positive.
As regard disease severity, we revealed that (42.5%) were in mild form, (42.5%) moderate form followed by severe form (12.5) and only one case was end stage (2.5%) according to Medsger score (Medsger et al., 2003).
By examining femoral cartilage thickness by musculoskeletal ultrasound, we found that (60%) of patients had thin femoral cartilage of knee joint.
According to vitamin D level; we found that (35%) of patients had sufficient vitamin D level while (65%) of patients had insufficient vitamin D level.
There was significant relation between the studied groups according to sex of studied patients with more insufficiency ratio in females (P=0.037).
There was significant relation between studied groups according to proximal muscle weakness (P=0.045).
There was highly significant inverse relation between age and femoral cartilage thickness at Rt medial condylar area, also shows significant inverse relation with parity in females at Rt intercondylar area and Rt medial condyle.
Vitamin D level was related to femoral cartilage thickness at left medial condylar area and left lateral condyle, meanwhile we found no relation between disease severity and cartilage thickness or vitamin D level.
There was highly significant statistical relation between disease severity grades and proximal muscle weakness among studied patients.