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LUCA BERTINOTTI, MARZIA MORTILLA, MARIA LETIZIA CONFORTI, NICOLA COLANGELO, FRANCESCA NACCI, ANGELA DEL ROSSO, CLAUDIO FONDA, ROBERTO CASALE, MARCO MATUCCI-CERINIC, and ALBERTO PIGNONE

ABSTRACT.

Objective. Involvement of the central nervous system (CNS) in systemic sclerosis (SSc) is rare. Proton magnetic resonance spectroscopy (¹H-MRS) assesses in vivo cerebral metabolites. We investigated the biochemical modifications of the CNS in SSc.

Methods. N-acetylaspartate/creatine ratio (NAA/Cr) and choline/creatine ratio (Cho/Cr) at right centrum semiovale (RCS) and at right basal ganglia (RBG) were evaluated by ¹H-MRS in 12 patients with limited (lSSc) and 8 patients with diffuse SSc (dSSc) and 20 control subjects.

Results. With ¹H-MRS, a significant reduction of NAA/Cr ratio at RBG (p < 0.02) and at RCS (p < 0.002) was detected in SSc patients. Cho/Cr ratio was increased (p < 0.02) in the RCS, but not in RBG. In patients with lSSc, a significant reduction of NAA/Cr was detected in RCS but not in RBG.

Conclusion. Evidence of neuroaxonal damage strongly suggests the existence of CNS involvement in SSc. (J Rheumatol 2006;33:546–51)

Key Indexing Terms:

SYSTEMIC SCLEROSIS
PROTON MAGNETIC RESONANCE SPECTROSCOPY
CENTRAL NERVOUS SYSTEM
NEUROMETABOLIC ALTERATIONS

From the Department of Medicine, Section of Rheumatology, University of Florence; Radiology Unit, Children's Hospital Anna Meyer, Florence; and the Neurophysiology Unit, Fondazione del Lavoro, IRCCS, Montescano, Italy.

L. Bertinotti, MD, Department of Internal Medicine, Section of Rheumatology, AOUC, University of Florence; M. Mortilla, MD, Radiology Unit, Children's Hospital Anna Meyer; M.L. Conforti, MD; N. Colangelo, MD; F. Nacci, MD; A. Del Rosso, MD, PhD, Department of Internal Medicine, Section of Rheumatology, AOUC, University of Florence; C. Fonda, MD, Radiology Unit, Children's Hospital Anna Meyer; R. Casale, MD, Neurophysiology Unit, Fondazione del Lavoro, IRCCS; M. Matucci-Cerinic, MD, PhD; A. Pignone, MD, PhD, Department of Internal Medicine, Division of Medicine II, AOUC, University of Florence.

Address reprint requests to Dr. M. Matucci-Cerinic, Department of Internal Medicine, Villa Monna Tessa, Division of Medicine I and Rheumatology, Headache, and Nephrology, Viale G. Pieraccini 18, 50139 Florence, Italy. E-mail: cerinic@unifi.it

Accepted for publication October 19, 2005.