Impaired Hand Function and Daily Activities Significant Even Among Patients With Low Disease Activity in SLE

Impaired hand function and difficulties in performance of daily activities are significant among patients with systemic lupus erythematosus (SLE), even among those who achieved lupus low disease activity state (LLDAS), according to study results published in Rheumatology Advances in Practice.

Musculoskeletal manifestations are common among patients with SLE, with potential involvement of the hand joint, ranging from transient or migratory arthralgia to persistent arthritis. As limited data are available on hand function and activities of daily living (ADL) performance, the objective of the current study was to assess hand function and performance in ADL in patients with SLE vs healthy individuals, and to determine the association with demographic and disease-related characteristics.

The study included adult patients with SLE, based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, and received follow-up care at 2 general hospitals in Athens, Greece. All patients underwent a detailed physical examination, and 2 questionnaires were used to assess ADL performance – the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Health Assessment Questionnaire (HAQ).

Lupus disease activity was evaluated using the SLE disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology Damage Index (ACR-DI).

The cohort included 240 patients with SLE (mean age, 47.63±13.01 years; 90% women) and 122 age- and sex-matched healthy control participants (mean age, 47.96±12.67 years; 88.5% women). Mean SLICC/ACR-DI was 0.49, and 157 (65%) patients achieved LLDAS at the time of evaluation.

All hand function variables, including grip strength, pinch strength, and dexterity in both hands, were statistically significantly lower among patients with SLE compared with healthy control participants (P <.05). Compared with participants in the control group, patients in the SLE group had greater difficulty in ADL performance, with significant differences in median values of DASH (0.83 vs 10, respectively) and HAQ (0 vs 0.25, respectively).

Both DASH and HAQ scores were better among patients with SLE achieving LLDAS compared with those not achieving LLDAS. However, compared with healthy control participants, patients who achieved LLDAS had greater difficulties in ADL and decreased pinch strength and dexterity, according to the Purdue Pegboard Test.

There was a significant correlation between DASH and grip strength; for every 1-unit increase in DASH score or HAQ score, the grip strength decreased by 0.19 kg (P <.001) and 7.5 kg (P <.001), respectively.

In multiple regression models, joint pain was the most frequent and significant predictor of hand dysfunction and ADL performance. Arthritis was significantly correlated with ADL performance, according to DASH and HAQ, but not with grip strength and dexterity. Age was negatively correlated with grip strength and hand dexterity, according to Purdue score, but it did not correlate with ADL performance.

Among those with low disease activity, age, sex, and immunosuppressive use were independent predictors of decreased grip strength. There was a correlation between painful joints with DASH and HAQ. Age and history of major events were significantly associated with decreased Purdue scores.

The study had several limitations, including the limited number of patients with severe disease activity and that all patients were White, thus decreasing the generalizability of these findings.

“The assessment of hand function and ADL performance abnormalities should be included in the daily clinical evaluation of patients with SLE and appropriate hand therapy programs consisted of exercise (strengthening and stretching exercises), soft tissue procedures, dexterity training, pain management, range of motion activities, splinting, etc, should be introduced accordingly,” the researchers concluded.

Reference

Keramiotou K, Anagnostou C, Konstantonis G, Kataxaki E, Sfikakis PP, Tektonidou MG. Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving Lupus Low Disease Activity State (LLDAS). Rheumatol Adv Pract. Published online May 5, 2021. doi:10.1093/rap/rkab029