Image in medicine
Mechanic's hand: Tip of the iceberg in evolving connective tissue disorders
Manos de mecánico: La punta del iceberg en la evolución de los trastornos del tejido conectivo
a Maulana Azad Medical College, New Delhi, India
b Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
c Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
d Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
e City Hospital Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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However, muscle strength and chest examination were normal and HRCT chest ruled out silent ILD (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Labs suggested positive anti-CCP antibodies (44.3 units), rheumatoid factor (107 units), and high C-reactive protein (6.95<span class="elsevierStyleHsp" style=""></span>mg/L), while hand radiographs depicted erosive arthritis and juxta-articular osteopenia. On myositis profile, anti-PM/Scl antibodies were positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">MH are thought to indicate a diagnosis of ASSD, although the organ involvement at the outset may be limited, with progression to the full spectrum of the syndrome in 25–50% of patients per year. However, recent research suggests that MH may not be a sine qua non for ASSD, rather way more common in other connective tissue diseases (CTDs). Notably, patients with anti-PM/Scl-positive CTDs may often exhibit MH. Furthermore, anti-PM/Scl positive myositis is known to share pathogenetic and genetic predispositions with ASSD.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, cases with seropositive arthritis with the classic radiograph picture may have underlying undiagnosed CTD with future prognostic implications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 479 "Ancho" => 1740 "Tamanyo" => 154280 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015900000001/v1_202206300527/S0025775322000835/v1_202206300527/en/main.assets" "Apartado" => array:4 [ "identificador" => "93344" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015900000001/v1_202206300527/S0025775322000835/v1_202206300527/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775322000835?idApp=UINPBA00004N" ]
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