Clinical Image

Knee Pain in Systemic Sclerosis (Ssc)

Popp F1*, Kellner J2, Kempis J1, Welcker M3 and Müller R1
1Department of Rheumatology, Kantonsspital St. Gallen, Switzerland
2Department of Radiology, Kantonsspital St. Gallen, Switzerland
3MVZ für Rheumatologie Dr. M. Welcker, Germany

*Corresponding author: Florian Popp, Department of Rheumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95 9007 St. Gallen, Switzerland

Published: 14 Mar, 2017
Cite this article as: Popp F, Kellner J, Kempis J, Welcker M, Müller R. Knee Pain in Systemic Sclerosis (Ssc). Ann Clin Case Rep. 2017; 2: 1305.

Clinical Image

A 56-year-old female patient diagnosed with SSc (2013 ACR-/EULAR-criteria; mRSS = 6/51) and steroid-induced osteopenia (T-score -1.0 SD neck, -0.5 SD total hip, Vitamin D3 71 nmol/l) presented with left knee pain, progressing over the last months. Serologically no inflammation was found. Radiographs of the affected knee (Figure 1A) showed diffuse osteosclerosis along the medial tibial plateau without signs of fracture (arrows). Because of persisting pain a MRI (Figure 1B and C) was conducted six months later. It revealed a horizontal insufficiency fracture of the tibial head (stars), which was treated by endoprothetic surgery followed by bisphosphonates. In summary, the horizontal fracture of the tibial head lead to the diagnosis of osteoporosis. The prevalence for osteoporosis and associated fractures is increased in women with SSc [1,2], which is discussed to be an independent risk factor [3]. Consequently, imaging should be extended beyond conventional radiographs in SSc patients with unexplained joint or bone pain.

Figure 1

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Figure 1
Radiographs of the affected knee.


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  2. Atteritano M, Sorbara S, Bagnato G, Miceli G, Sangari D, Morgante S, et al. Bone mineral density, bone turnover markers and fractures in patients with systemic sclerosis: a case control study. PLoS One. 2013; 8(6): e66991.
  3. Souza RB, Borges CT, Takayama L, Aldrighi JM, Pereira RM. Systemic sclerosis and bone loss: the role of the disease and body composition. Scand J Rheumatol. 2006; 35(5): 384-387.