Hand function in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease. Involvement of wrist and hand is a characteristic finding and occur at an early stage. Hand function is of great importance in performance of daily activities (ADL).Aims. We wanted to study the effects of hand exercise and wax bath treatment in patients with RA and to develop a clinical hand function test. We also wanted to study predictors of hand function and to study changes of hand function and ADL in patients followed for five year. Moreover, we investigated the precision grip lift sequence.Method. Eighty-three females and 32 males with RA from the Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden, participated and 27 females and five males were used as healthy controls in the studies. Hand function tests, upper extremity mobility measures, grip strength, pain and stiffness as well as precision grip-lift performance and self reported ADL abilities were evaluated.Results. Hand exercise improved hand function and reduced pain and stiffness. Surface heat may act supportive to exercise. A clinical hand function test, Grip Ability Test (GAT), was developed. The GAT consists of three items, does not require sophisticated equipment and takes less than 5 min to perform. GAT is valid, has a good inter- and intra-observer reliability, is sensitive to change and correlated well to performance of ADL tasks. Observer assessed hand function tests were best predicted by joint motion in fingers whereas grip strength displayed strongest influence on self estimated hand function. The five-year follow-up study revealed that females declined in hand function, upper extremity function and ADLs. In contrast, males did not deteriorate. Patients with RA displayed a disturbed precision grip-lift performance, Conclusions. Active hand exercise and wax bath treatment may improve hand function and reduce pain and stiffness in patients with established RA. The Grip Ability Test is valid, reliable clinical hand function test, which is easy to perform. A sex difference was noted with regards to decline of hand function and ADL over time. The precision grip-lift performance in females with RA was disturbed indicating a need for further investigations concerning etiological mechanisms. Extended knowledge of the complex interplay of hand function in RA will result in more adequate and addressed measures.