Objective Arthritis is associated with a worse prognosis in established systemic sclerosis (SSc). However, knowledge about its relevance in very early SSc (veSSc) is scarce. We aimed to assess the prevalence and phenotype of arthritis, as well as its prognostic impact, in patients with veSSc. Methods We analysed patients with veSSc, defined as presence of Raynaud’s phenomenon and/or at least one of: puffy fingers, antinuclear antibodies (ANA), abnormal capillaroscopy, not fulfilling the ACR/EULAR classification criteria for SSc at baseline. We investigated associations between arthritis and clinical parameters, followed by a longitudinal analysis to investigate arthritis as a potential predictor of progression towards established SSc. Results We included 159 patients, of whom 108 had at least one follow-up visit. SSc-related arthritis occurred in 22/159 (13.8%) patients at baseline. Arthritis was mostly seronegative, symmetrical, oligo- or polyarticular, non-erosive, and rarely associated with elevation of inflammatory markers. More than half of the patients needed treatment with DMARDs. Anti-centromere antibodies were negatively associated with arthritis (OR: 0.707, 95% confidence interval 0.513–0.973, p = 0.033). Overall, 43/108 (39.8%) patients with follow-up progressed to established SSc during the observation time. Arthritis was not a significant predictor for progression to established SSc in a multivariable Cox regression. Conclusion In this first comprehensive analysis, we found a similar prevalence of arthritis in veSSc as seen in established SSc. Moreover, the use of DMARDs indirectly suggests a relevant disease burden.

中文翻译：

---

极早期系统性硬化症患者的关节炎：全面的临床和预后分析

目的 关节炎与已确诊的系统性硬化症 (SSc) 的预后较差相关。然而，关于其在非常早期的 SSc (veSSc) 中的相关性的知识却很少。我们的目的是评估 veSSc 患者关节炎的患病率和表型及其预后影响。方法 我们分析了 veSSc 患者，其定义为存在雷诺现象和/或至少一种：手指浮肿、抗核抗体 (ANA)、毛细血管镜检查异常、基线时不符合 ACR/EULAR 分类标准。我们研究了关节炎与临床参数之间的关联，然后进行纵向分析，以研究关节炎作为已确定的 SSc 进展的潜在预测因素。结果 我们纳入了 159 名患者，其中 108 名至少接受过一次随访。基线时 22/159 (13.8%) 名患者发生 SSc 相关关节炎。关节炎大多为血清阴性、对称、寡关节或多关节、非糜烂性，很少与炎症标志物升高相关。超过一半的患者需要接受 DMARD 治疗。抗着丝粒抗体与关节炎呈负相关（OR：0.707，95% 置信区间 0.513–0.973，p = 0.033）。总体而言，43/108 (39.8%) 的随访患者在观察期间进展为确诊的 SSc。在多变量 Cox 回归中，关节炎并不是进展为 SSc 的重要预测因素。结论 在第一个综合分析中，我们发现 veSSc 中关节炎的患病率与已建立的 SSc 中相似。此外，DMARD 的使用间接表明相关的疾病负担。