Background:Handgrip muscle strength test describes the strength of the hand muscles used to grasp or grip. Currently, hand grip evaluation is often used in clinical practice, as a marker of function and disability. In fact, it has already been applied as an outcome measure in arthritis rheumatoid clinical trials, to demonstrate the benefits of several treatments [1]. However, hand disability should also be considered in all other rheumatological diseases.Objectives:The main aim of this study is to assess the handgrip muscle strength test in a rheumatological cohort of patients as compared to a control group.Methods:This is a cross-sectional pilot study. We considered eligible 35 rheumatological consecutive female patients followed at our outpatients’ clinic of Internal Medicine (I Policlinico of Naples) and 35 healthy control females (HC). Both groups included only right-handed individuals. Rheumatological patients were distributed as follows: 5 rheumatoid arthritis (14,3%), 9 psoriatic arthritis (25,7%), 4 systemic lupus erythematosus (11,4%), 10 systemic sclerosis (28,6%), 4 fibromyalgia (11,4%), 3 juvenile idiopathic arthritis (8,6%). The course of disease was under optimal treatment in all patients.The type of hand grip used is the power grip, in which an object is held firmly by wrapping the fingers around it, pressing the object against the palm, and using the thumb to apply counter-pressure. We considered as either right or left hand valid measure the mean of three consecutive tests per arm. Between-groups differences were tested both by a uni- and multivariable analysis.Results:The two subgroups were homogeneously distributed for age (median age 42 yrs. [IQR 33-48] vs. 36 yrs. [IQR 30-52] in HC; p=0.902). At univariate analysis, hand grip strength was significantly lower in the rheumatological patients, both at right hand (right 19.5 kg [IQR 13.6-24.8] vs. 24.5 kg [IQR 20.8-29] in HC; p=0.004) and left hand (18.5 kg [IQR 13.9-22.5] vs. 23.7 kg [IQR 19-27.3] in HC; p=0.002), as compared to HC. This finding was further confirmed at multivariable analysis only as for the left hand (OR 0.919, 95%CI: 0.858-0.984; p=0.016).Conclusion:Rheumatological diseases are burdened by hand disability, mostly affecting daily activities performance [2,3]. Beyond an optimal disease control, our pilot study shows a decrease in left hand strength as compared to healthy controls. This might be due to a reduced use of the non-dominant hand, which may lead over time to a higher deficit of strength. As such, these patients should be prescribed to a left hand exercise to improve both mobility and strength and, consequently, hand function.References:[1]Eberhardt K, Sandqvist G, Geborek P (2008) Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol 37(2):109–112.[2]Feced Olmos CM, Alvarez-Calderon O, Hervás Marín D, et al. Relationship between structural damage with loss of strength and functional disability in psoriatic arthritis patients. Clin Biomech (Bristol, Avon). 2019 Aug;68:169-174. doi: 10.1016/j.clinbiomech.2019.06.009.[3]Maddali-Bongi S, Del Rosso A, Mikhaylova S, et al. Impact of hand and face disabilities on global disability and quality of life in systemic sclerosis patients. Clin Exp Rheumatol. 2014 Nov-Dec;32(6 Suppl 86):S-15-20.Disclosure of Interests:None declared
Possibilities of nailfold capillaroscopy in the differential diagnosis of immuno-inflammatory and rheumatological diseases
