A longitudinal follow-up of hand involvement and activities of daily living in early systemic sclerosis.

OBJECTIVE

To investigate the development of hand involvement and activities of daily life (ADL) in early systemic sclerosis (SSc), and to examine the usefulness of the Hand Mobility in Scleroderma (HAMIS) test in a longitudinal study.

METHODS

Forty-three patients with disease duration no longer than 3 years and at least 4 years of follow-up formed the study group. Based on skin involvement, 31 patients were classified as limited cutaneous SSc (lcSSc) and 12 as diffuse cutaneous SSc (dcSSc). The patients were assessed regarding hand function [mobility (HAMIS), grip force (Grippit), and self-assessed hand function visual analogue scale (VAS)], vascular involvement [Raynaud's phenomenon (RP)], skin involvement [modified Rodnan skin score (mRss)], and ADL capacity [the scleroderma Functional Score (FS)].

RESULTS

Hand mobility and ADL capacity were in general good and did not change significantly. However, at the individual level 72% of the patients showed a change in HAMIS score. Grip force and perceived hand function were moderately impaired at baseline and during the follow-up. Skin involvement in the hand/arm improved significantly (p<0.001). During the observation period, the hand/arm mRss and HAMIS score changed in parallel (r(s) = 0.58, p<0.001). ADL capacity correlated significantly with grip force, self-assessed hand function, and RP at baseline, and also with HAMIS at follow-up.

CONCLUSIONS

In this study hand mobility and ADL capacity were maintained during the first years of SSc. HAMIS was found to be a feasible test for longitudinal assessment of hand mobility in SSc.