The Relevance of Hand Mobility and Functionality Surveillance in Patients with Systemic Sclerosis

Abstract

Introduction: Systemic sclerosis causes skin thickening, Raynaud’s phenomenon, visceral damage, and musculoskeletal issues. Hand impairment, affecting about 90% of patients, limits mobility, dexterity, and grip strength, significantly impacting daily life, with few treatment options. This study aims to characterize hand function in patients with Systemic Sclerosis and, secondarily, to describe those undergoing rehabilitation and using assistive devices.
Material and methods: This cross-sectional observational study included Systemic Sclerosis patients from Rheumatology service care meeting 2013 American College of Rheumatology/European League Against Rheumatism Systemic Sclerosis criteria. Sociodemographic and clinical data were collected through anonymous questionnaires. The exclusions were based on the inability to contact the patient, refusal to participate in the study due to transportation costs, and incompatibility with work schedules. Data included age, gender, education, employment, disease subtype, systemic involvement, symptom duration and diagnosis duration. Hand rehabilitation and assistive device usage were assessed. Additionally, hand and fingers’ skin thickness was assessed using the modified Rodnan Skin Score. Hand mobility was evaluated by the Modified Hand Mobility in Scleroderma, and Grip was measured by Jamar dynamometer. Disability status, quality of life and hand function were appraised using the Health Assessment Questionnaire, Medical Outcomes Short Form-36 and Cochin Hand Functional Scale, respectively. The data were analyzed using the International Business Machines Corporation Statistical Package for the Social Sciences software, version 29 (International Business Machines Corporation, 2023). We performed descriptive statistics. A linear regression for Cochin Hand Functional Scale score included variables marginally or significantly associated in univariate analysis, adjusting for various factors.
Results: A total of 32 patients participated, predominantly female, with Limited Systemic Sclerosis. Few used assistive devices (18.8%) or received hand rehabilitation (14.3%). Cochin Hand Functional Scale median score was 5.0, with 10.5 for the third quartile, indicating low functional compromise, and only four patients had this scale score H 25. Hamis score was significantly associated with Cochin Hand Functional Scale (adjusted R-squared = 0.80), explaining 80% variability.
Conclusion: This study underscores the need for continuous assessment of hand mobility and function, as well as the implementation of a multidisciplinary approach in the management of patients with Systemic Sclerosis.