Osteonecrosis of the lunate in systemic sclerosis—an underappreciated vascular complication?

Excerpt

A 71-year-old lady with known diffuse cutaneous SSc (anti-scl-70 positive) reported non-inflammatory arthralgias in the small joints of the hands and wrists in keeping with osteoarthritis. Her disease (9-year history) was characterised by digital vasculopathy: Raynaud’s phenomenon (10-year history) with previous digital ulcers and lung fibrosis/pulmonary hypertension. Current medication for SSc vasculopathy consisted of sildenafil and bosentan. Plain radiograph revealed established unilateral lunate osteonecrosis with secondary scapholunate advanced collapse (SLAC wrist), and evidence of generalised arthropathy, calcinosis and acro-osteolysis (Fig. 1a, b). Of note, the patient had also previously developed avascular necrosis of the head of the third metatarsal (Freiberg disease) (Fig. 1c).

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