Band acro-osteolysis in systemic sclerosis.

A 63 year old woman with an established diagnosis of diffuse systemic sclerosis presented to rheumatology clinic with swelling of her fingers. On examination, her fingers were mildly swollen. There was no evidence of digital ulceration or Raynaud's phenomenon. Her serological profile included positivity for anti-nuclear antibody (1:5120) and anti-PM/SCL -70 antibodies on Western blot. Plain radiographs of the hands demonstrated resorption of at least 50% of the distal phalanges of nine out of ten digits with preservation of the terminal tufts (see image 1). Her parathyroid hormone, calcium and vitamin D were within normal limits. There was no history of exposure to polyvinyl chloride, she did not play the guitar and there was no relevant family history. There were no clinical features to suggest Hajdu-Cheney syndrome or pyknodysostosis. The radiographic appearances reflected band acro-osteolysis secondary to diffuse systemic sclerosis.