Evaluation of hand function and functional capacity in women with scleroderma

Abstract

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease that predominantly affects women. It is characterized by skin rigidity, especially on the hands, resulting in significant limitation of finger movement. In addition, the appearance of calcifications in the phalanges, telangiectasias,digital ulcers and Raynaud’s syndrome which contribute to loss of functionality, is common. These conditions directly affect quality of life, making it difficult to perform essential daily activities and leading to physical deterioration, with loss of functional Independence, especially of the hands. Objective: To evaluate the functional capacity of the hands in women with systemic sclerosis (wwSSc) using the Glittre-ADL-Shelf (TGlittre-S) test and to correlate it with indicators of digital dexterity, muscle strength, lung function and physical function. Methods: This was a cross-sectional study involving 41 women diagnosed with SS and 41 healthy controls. Participants completed a series of assessments, including the Cochin Hand Function Scale (CHFS), modified Rodnan Skin Score (mRSS), Health Assessment Questionnaire-DI (HAQ-DI), 9-Hole Pinch Test (9-HPT), handgrip strength (HGS), and pulmonary function tests. The shelf phase of the TGlittre-S was used to assess hand functional capacity, excluding activities involving squatting. Results: The results showed that the time to complete the TGlittre-S was significantly longer in women with SS compared with healthy controls (60 seconds versus 44 seconds, p < 0.0001). The time to complete the 9-HPT was also longer in women with SS (24 seconds versus 20 seconds, p < 0.0001), and the CHFS score was higher (6 points versus 0 points, p < 0.0001). TGlittre-S time was significantly correlated with handgrip strength (r_s = -0.511, p = 0.0006), HAQ-DI (r_s = 0.510, p = 0.0006), 9-HPT (r_s = 0.398, p = 0.009) and CHFS (r_s = 0.351, p = 0.024). However, no significant correlation was found between TGlittre-S time and lung function. Conclusion: It is concluded that in women with SS, the functional capacity of the hands is severely impaired, with longer TGlittre-S times and worse handgrip strength, digital dexterity, and physical function. TGlittre-S proved to be an effective tool to assess hand functional disability and can be incorporated into clinical practice as a relevant outcome measure for future studies in SS. This method can help monitor disease progression and assess its impact on hand functionality.