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Rheumatology Advance Access published online on September 27, 2005
Rheumatology, doi:10.1093/rheumatology/kei101
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 24, 2005
Accepted August 5, 2005

Concise Report

Thymus alterations and systemic sclerosis

C. Ferri 1*, M. Colaci 1, L. Battolla 2, D. Giuggioli 1, and M. Sebastiani 1

1 Rheumatology Unit, University of Modena & Reggio Emilia and Policlinico di Modena, Modena
2 Division of Radiodiagnostic II, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.

* To whom correspondence should be addressed.
C. Ferri, E-mail: clferri{at}unimo.it


  Abstract

Objectives. The pathogenesis of systemic sclerosis (SSc) includes complex alterations to the immune system, possibly responsible for diffuse microvasculature and fibroblast dysfunction. Previous anecdotal observations suggest a possible role for thymus alterations in some autoimmune rheumatic diseases, including SSc. This study aimed to investigate the prevalence of radiological thymus alterations in SSc patients.

Methods. Thirthy-four unselected patients [28 female and 6 male, mean age (± s.d.) 49.7 ± 9.5 yr, range 33-67 yr] and 34 age- and sex-matched controls were included in the study. The presence of major radiological thymus alterations, i.e. an abnormally enlarged or nodular thymus, were blindly investigated by means of unenhanced multidetector computed tomography.

Results. Abnormally enlarged or nodular thymuses were detected in a statistically significant percentage of SSc patients compared with controls (21 vs 0%, P = 0.011). More interestingly, radiological thymus alterations were invariably observed in patients with shorter disease duration (≤5 yr, 41% vs >5 yr, 0%; P = 0.007), frequently associated with serum anti-Scl70 antibodies (P = 0.017). Among patients with thymus alterations one developed myasthenia gravis while two others showed thymus hyperplasia at histopathological evaluation after thymectomy.

Conclusions. The present study suggests a possible role of thymic disorders, mainly thymus hyperplasia, in a significant number of SSc patients. Due to the limitations of radiological evaluation, the actual relevance of such an association might be underestimated. The relationship of thymus alterations with shorter disease duration, as well as with serum anti-Scl70, suggests that thymic dysfunction could play a pathogenetic role mostly in the early phases of the disease, and possibly in specific SSc patient subsets.

Keywords: Systemic sclerosis; Scleroderma; Thymus; Thymus hyperplasia; Computed tomography.
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