Digital ulcers and acro-osteolysis in mixed connective tissu
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Digital ulcers and acro-osteolysis in mixed connective tissue disease, a 29-year-old man presented with painful fingertip ulcers. He was diagnosed with MCTD based on a 2-year history of Raynaud’s phenomenon, swollen hands, symmetrical polyarthritis of the small joints of the hands and wrists, and positive antinuclear (1 : 2560, speckled pattern) and anti-RNP (80 U/ml, normal value less than 15 U/ml) antibodies. Anti-centromere and anti-Scl-70 antibodies were negative. Upon physical examination, he had sclerodactyly, shortened distal phalanges of index and middle fingers, bilateral palmar retraction and fingertip ulcers (Fig. 1A and B).

Radiography of the hands (Fig. 1C) showed bone resorption of the distal phalanges. Nailfold capillaroscopy revealed an active SSc pattern (Fig. 1D). Acro-osteolysis or bone resorption of the distal phalanges of the hands and feet is observed in various disorders, such as SSc, psoriatic arthritis, hyperparathyroidism, leprosy, exposure to polyvinyl chloride and genetic disorders, among others. MCTD, a disease with overlapping features of SSc, SLE, and PM/DM, can also be associated with resorption of distal phalanges. As in SSc, the occurrence of acroosteolysis in MCTD is associated with severe digital ischemia due to small vessel damage and decreased capillary density, leading to an impaired blood flow that may cause the terminal tuft resorption.

Source: https://academic.oup.com/rheumatology/article-abstract/59/6/1460/5607529?redirectedFrom=fulltext
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