Division of Rheumatology, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
Clin Rheumatol. 2019 Sep;38(9):2309-2318. doi: 10.1007/s10067-018-04422-z. Epub 2019 Jan 12.
The condition known as 'Mechanic's Hands' is a thickened, hyperkeratotic eruption, which is bilaterally symmetric along the fingers, and often occurs in patients with some connective tissue diseases. Nail fold capillaroscopy is a non-invasive technique for evaluation of connective tissue diseases. We evaluated the prevalence of mechanic hands in patients with connective tissue diseases and compared the clinical manifestations and capillaroscopic changes in the patients with and without mechanic hands.
The clinical manifestations and capillaroscopy of 576 patients with scleroderma, dermatomyositis, systemic lupus erythematosus, Sjogren's syndrome, undifferentiated and mixed connective tissue diseases were evaluated and compared in patients with and without mechanic hands.
A total of 576 patients were enrolled. Mechanic hands were observed in 17.2% of patients: 50% of mixed connective tissue disease, 35% of dermatomyositis, 15.4% of scleroderma, 14.9% of undifferentiated connective tissue disease, 14.3% of Sjogren's syndrome, and no patient with SLE. Among them, 80.8% had abnormal capillaroscopic findings. In dermatomyositis patients, Raynaud's phenomenon, anti-Jo-1 positivity, and some capillaroscopy findings were detected more frequently in patients with mechanic hand. In scleroderma, positive Scl70 and capillary loss were observed more frequently in patients without mechanic hands.
Mechanic hands can be a presenting sign of some systemic connective tissue diseases. Probably, finding this sign on examination, especially together with Raynaud's phenomenon or abnormal capillaroscopy, can be helpful in the early diagnosis of the connective tissue diseases and can be used as a predictive and prognostic tool in future studies.
“技工手”是一种增厚的、过度角化的皮疹，沿手指双侧对称出现，常发生于某些结缔组织疾病患者中。甲襞毛细血管镜检查是评估结缔组织疾病的一种非侵入性技术。我们评估了结缔组织疾病患者中“技工手”的患病率，并比较了有和无“技工手”患者的临床表现和毛细血管镜变化。
评估了 576 例硬皮病、皮肌炎、系统性红斑狼疮、干燥综合征、未分化和混合结缔组织病患者的临床表现和毛细血管镜，并比较了有和无“技工手”患者的差异。
共纳入 576 例患者。“技工手”见于 17.2%的患者：混合结缔组织病占 50%，皮肌炎占 35%，硬皮病占 15.4%，未分化结缔组织病占 14.9%，干燥综合征占 14.3%，无系统性红斑狼疮患者。其中，80.8%有异常毛细血管镜发现。在皮肌炎患者中，技工手患者更常出现雷诺现象、抗 Jo-1 阳性和某些毛细血管镜发现。在硬皮病患者中，无技工手患者更常出现 Scl70 阳性和毛细血管缺失。
“技工手”可能是某些系统性结缔组织疾病的首发表现。因此，在体格检查中发现该表现，尤其是伴有雷诺现象或异常毛细血管镜，可能有助于结缔组织疾病的早期诊断，并可作为未来研究的预测和预后工具。
