Vliet Vlieland T P, van der Wijk T P, Jolie I M, Zwinderman A H, Hazes J M
Department of Rheumatology, University Hospital Leiden, The Netherlands.
J Rheumatol. 1996 May;23(5):835-40.
To investigate which clinical variables contribute to the function of the hand in activities of daily living (ADL) in patients with rheumatoid arthritis (RA).
In 50 patients with RA hand function in ADL was assessed by (1) the dexterity items of the Arthritis Impact Measurement Scales (AIMS), (2) direct observation of the same items by an occupational therapist, and (3) the Jebsen hand function test. A combined hand function factor was constructed by principal component analysis of the 3 hand function measures. Further assessments included measurements of muscle strength, deformity and destruction, range of motion, and local arthritis activity. After bivariate analyses, variables that correlated significantly with the measures of hand function were entered into stepwise multiple regression analyses.
The variables having a significant correlation with most of the hand function measures were: pinch and grip strength, patient's assessment of pain and stiffness of the hands, flexion of the thumb and fingers, range of motion of the wrist, alignment of the metacarpophalangeal (MCP) joints, swan neck and Z deformities, and the Larsen erosion score. 78% of the variance of the combined hand function factor could be explained by pinch strength, stiffness of the hands, and the presence of Z deformity and ulnar deviation.
Pinch and grip strength should be carefully considered in setting goals for conservative or surgical treatment of the rheumatoid hand. In addition, reported stiffness of the hands, malalignment of the MCP joints, and flexion and deformity of the thumb were the most consistent indicators of impaired hand function.
探讨哪些临床变量对类风湿关节炎（RA）患者日常生活活动（ADL）中的手部功能有影响。
对50例RA患者的ADL手部功能进行评估，方法如下：（1）采用关节炎影响测量量表（AIMS）的灵活性项目；（2）由职业治疗师直接观察相同项目；（3）进行Jebsen手部功能测试。通过对这3项手部功能测量指标进行主成分分析构建综合手部功能因子。进一步评估包括肌肉力量、畸形与破坏、活动范围以及局部关节炎活动度的测量。经过双变量分析后，将与手部功能测量指标显著相关的变量纳入逐步多元回归分析。
与大多数手部功能测量指标显著相关的变量有：捏力和握力、患者对手部疼痛和僵硬的评估、拇指和手指的屈曲、腕关节活动范围、掌指（MCP）关节对线、天鹅颈和Z形畸形以及Larsen侵蚀评分。捏力、手部僵硬程度、Z形畸形和尺侧偏斜的存在可解释综合手部功能因子78%的方差。
在为类风湿性手部疾病制定保守或手术治疗目标时，应仔细考虑捏力和握力。此外，报告的手部僵硬、MCP关节对线不良以及拇指的屈曲和畸形是手部功能受损最一致的指标。
