Roentgenographic Manifestations of Joint Disease in Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a disease of multiple organ systems. It is apparently noninfectious and represents a connective tissue response to an as yet unknown stimulus. Prior to the report in 1948 of Hargraves and his associates (10) describing the “L.E.” phenomenon, systemic lupus erythematosus was considered an esoteric disease. Its clinical manifestations are dependent upon the involved organ system. Although symptoms of the musculoskeletal system are common, death is not usually caused by disease of muscles or bone, but in most cases results from visceral involvement. Many articles in the English literature have reviewed SLE, but to our knowledge a systematic evaluation of the radiographic features of the joint has not been accomplished (5–13, 15, 17–19, 22–24, 29–30). Material and Method The present report is based on a study of 25 available patients whose disease had been diagnosed as classic or definite SLE. They were selected from several hundred recorded at various institutions in the San Francisco area, by means of a screening guide which utilized clinical and laboratory criteria. In obtaining the history, and on examination of each patient, emphasis was placed on joint disease. Information was included regarding those diseases known to have radiologic characteristics similar to SLE (e.g., rheumatoid arthritis) or to its treatment (e.g., cortisone therapy). The more frequent clinical and laboratory findings were given numerical values in order of their importance and a diagnostic score was obtained (Table I). With scores greater than 10, SLE was considered classic, and with scores 6 to 10, definite. Patients with scores of less than 6 were not included in this study. Roentgenograms of major joint areas were obtained in survey manner, without reference to current joint symptoms (Table II). Additional roentgenograms were obtained, as necessary, for review and comparison. The clinical and radiographic observations were reviewed independently and then concurrently. Pathologic specimens of synovia, bone, and renal tissues were obtained, when indicated, at operation or by needle biopsy. Roentgenographs Findings The roentgenographic data correlated well with the current objective physical findings. The positive findings included joint erosion, destruction, effusion, narrowing, juxta-articular demineralization, subluxation or dislocation, or both, bone infarction, aseptic necrosis of bone, and abnormal joint calcification (Figs. 1–6). It is emphasized that roentgen evidence of either soft-tissue or joint changes was scant, even in those patients with arthralgia or with long-standing severe joint disease. In 2 patients with clinical joint deformities resembling rheumatoid arthritis, there was a relative lack of severe bone erosion or destruction at the sites of subluxation and/or dislocation (Figs. 2–3).