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OBJECTIVES: We describe a case of systemic sclerosis (SS) with acro-osteolysis associated with cutaneous mucinosis, usually characterized by mucin deposition in the skin. The main differential diagnosis was multicentric reticulohistiocytosis due to the presentation of papulonodular skin lesions. MATERIALS AND METHODS: A physical examination, imaging studies and laboratory tests were performed. RESULTS: Distal bone resorption was evident on plain radiographs, and skin biopsy confirmed mucinosis. The SS diagnosis was based on the clinical features, high levels of antinucleolar antibodies and typical nailfold capillaroscopy findings. CONCLUSION: To the best of our knowledge, this is the first description of cutaneous mucinosis accompanying SS with acro-osteolysis. LEARNING POINTS: Cutaneous mucinosis is rarely associated with systemic sclerosis.Systemic sclerosis with cutaneous mucinosis may resemble multicentric reticulohistiocytosis.
RESUMO
Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.