Hand function in systemic sclerosis: a clinical and ultrasonographic study

To evaluate hand impairment and functional disability in scleroderma patients using clinical and ultrasonographic [US] measures. Fifteen scleroderma patients and 10 age and sex-matched healthy controls were studied. Patients underwent clinical examination including modified Rodnan skin score. Hand function assessment included pinch and grip strength measurement, finger range of motion [ROM] assessment, Hand Mobility in Scleroderma [HAMIS] test and Hand Functional Index [HFI]. Hand disability was assessed by Health Assessment Questionnaire [HAQ], Scleroderma HAQ Visual Analogue Scale [SHAQ VAS] and Cochin scale. US hand examination included measuring hand skin thickness, screening of the finger flexor and extensor tendons, measuring cartilage thickness of the 2nd MCP joint, anteroposterior thickness of the flexor retinaculum, and surface area of the median nerve. Nine patients had healed digital ulcers while only one patient had active ulcers. Seven patients had arthralgia in the hand joints. The patients had a significant decrease in grip strength and finger ROM. By US, patients showed significant increase in hand skin thickness and flexor retinaculum thickness and a significant decrease in median nerve surface area. Hand disability measures showed variable significant correlations with pinch and grip strength and hand mobility measures which were significantly correlated with US skin thickness of the 2nd inter-metacarpal web space. Hand disability in scleroderma was mainly related to impaired hand mobility and also diminished strength. The use of US in adjunct to clinical examination refines the evaluation of hand impairment in scleroderma

Hand osteoarthritis: clinical and imaging study

To examine the validity of US in assessing hand osteoarthritis [OA] and to study the relationship between ultrasonographic findings and OA symptoms. This study was carried out on thirty patients with primary hand OA, and fifteen healthy subjects serving as a control group. Patients were classified according to ultrasonographic findings of joint involvement into two subgroups: 15 patients with interphalangeal [IP] OA and 15 patients with IP and first carpometacarpal [CMC] joint OA. All hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement [nodes], and deformity. Functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by Visual Analogue Scale [VAS] were carried out. Plain X-rays of both hands were taken and classified according to the Kellgren-Lawrence [K-L] grading scale. High resolution US of the hand joints was performed which focused on examining cartilage thinning, joint space narrowing [JSN], and osteophytes [OST]. There was a positive correlation between the K-L grading and US findings regarding JSN and OST. There was a positive correlation of AUSCAN score with cartilage thinning, OST and JSN. There was a negative correlation of grip strength with cartilage thinning and OST. There was a negative correlation between pinch strength and US findings [cartilage thinning, OST and JSN]. There was a positive correlation between pain and US findings. Heberden's nodes were associated with underlying distal IP cartilage thinning, OST and JSN. On comparing the two subgroups of patients; patients with both IP and first CMC joint involvement experienced significantly higher levels of pain and disability and had weaker pinch strength. Ultrasonographic findings correlated with clinical findings as nodes, functional parameters as grip and pinch strength, and pain. The increased detection of OA structural pathology by US may make this a useful tool for hand OA assessment

Hand osteoarthritis: correlation between functional evaluation, imaging and disease activity

This study aimed at investigating the relationship between functional evaluation, imaging and disease activity in hand Osteoarthritis. Twenty-five patients fulfilling the ACR criteria for classification of hand osteoarthritis were enrolled in this study. Full demographic data was obtained and all patients underwent thorough rheumatologic examination which included tender joint count as well as node count. The patients completed the AUSCAN questionnaire. Grip and pinch strength was measured bilaterally. Postero-anterior hand radiographs were taken and power doppler ultrasonography was performed on both hands. They all had ESR and ultrasensitive CRP measured. Seventeen patients [68%] had tender joints, 22 patients [88%] had nodes. Kellgren-Lawrence grading of the x-rays ranged from 2- 4. Grip and pinch strength were not correlated with OA severity or disease activity. Seventeen patients [68%] had positive power doppler findings indicative of synovitis. There was no correlation between doppler findings and hand function. Twenty-three patients [92%] had elevated ESR and twenty-four patients [96%] had elevated ultrasensitive CRP. There was a positive correlation between CRP and OA severity. However, CRP did not correlate with hand function. Tender joint count was positively correlated with pain, stiffness and functional disability [AUSCAN]. Tender joints also correlated with ESR. There was no correlation between tender joint count and power doppler findings. Tender joint count correlates well with lab findings and AUSCAN scoring. However, hand function measured both objectively and subjectively does not correlate with acute phase reactants or power doppler ultrasonography and radiographic findings in hand OA. It seems that hand function does not reflect disease activity or severity