Hand function impairment in Systemic Sclerosis: determinants through investigations of clinical, radiographic and ultrasonographic features.

OBJECTIVES

to investigate the impact of cutaneous, vascular, and musculoskeletal (MSK) involvements on hand function-related patient-reported outcomes (PROs) by assessing clinical, radiographic, and ultrasonographic (US) features in a real-world cohort of Systemic Sclerosis (SSc) patients.

METHODS

patients were enrolled in a multicentre cross-sectional study. PROs included Cochin Hand Function Scale (CHFS). Medical history and clinical examination, hands and wrists' ultrasonography and radiography were collected. Analogue data were obtained from an external validation cohort. Separate and pooled cohorts' analyses were conducted.

RESULTS

140 consecutive patients were enrolled from 3 centres. In both univariate and multivariate analyses, CHFS scores showed a significant correlation with modified Rodnan Skin Score (mRSS) (p<0.001) and with US-detected tenosynovitis (p<0.01). A trend was observed for the presence of US-detected tenosynovitis with a sclerosing pattern and for the presence of calcinosis, with statistically significant correlations in univariate analysis (p=0.01 and 0.02, respectively) but not in multivariate analysis (p=0.06 and 0.055, respectively).

CONCLUSION

our findings support the multifactorial origin of hand function impairment in SSc patients, with mostly contributions from cutaneous and MSK involvement. Skin fibrosis and US-detected tenosynovitis were the most significant variables explaining hand disability as measured by CHFS. Ultrasonography may represent a valuable complementary tool, assessing MSK disease severity and activity. WHAT WAS ALREADY KNOWN: cutaneous, vascular and musculoskeletal involvement contribute to hand function impairment in SSc patients WHAT WAS LEARNED FROM THIS STUDY: ● Skin fibrosis and US-detected tenosynovitis are the most relevant features. ● Ultrasonography may provide complementary information in the routine care of SSc patients.