Scleroderma is a collagen vascular disease of unknown etiology otherwise known as progressive systemic sclerosis. There is a generalized disorder of the microvasculature which causes and vascular compromise of the skin and other organ systems. It is three to four times more common in women than men.

The distal phalangeal tips, interphalangeal joints and surrounding soft tissues areas of the hand are the most commonly affected areas. There can also be preferential involvement of the 1st carpometacarpal joint. Much less frequently seen are radiographic changes at the other carpal bones.

Radiographic Findings:
Acroosteolysis can occur due to resorptive changes at the distal phlangeal tufts secondary to pressure from surrounding sclerotic soft tissues. The resorptive process often causes a sharpening of the phalanx, known as "penciling". The interphalangeal joints can also exhibit erosive changes; joint space narrowing is usually a late stage finding. Occasionally tendon sheath fibrosis can cause contracture deformities. Radiographic findings associated with the preferential involvement of the 1st carpometacarpal joint can include osteolysis of the trapezium and 1st metacarpal base, 1st metacarpal subluxation, and and intra-articular calcifications. Soft tissue subcutaneous and periarticular calcifications and soft tissue atrophy and thickening are common findings in scleroderma.

Rheumatoid, psoriatic, and erosive arthritis can sometimes be mistakenly diagnosed in place of scleroderma. However, scleroderma has fairly characteristic associated soft tissue findings which distinguish it from the others.


Rheumatoid Arthritis
Psoriatic Arthritis
Calcium Pyrophosphate Deposition Disease
Multicentric Reticulohistiocytosis
Silastic Arthritis
Septic Arthritis