Involvement of the wrist and hand joints and tendons in an Egyptian systemic lupus erythematosus cohort

Omneya Mohamed-Ayman Abdel-Moniem,Diaa Fahmy Mohasseb,Sherine El-Sherif,Yousra Hisham Abdel-Fattah,Mohamed Sami Barakat

doi:10.1186/s43166-020-00030-5

Omneya Mohamed-Ayman Abdel-Moniem, Diaa Fahmy Mohasseb + Show 3 more

Open Access

https://doi.org/10.1186/s43166-020-00030-5

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Abstract

BackgroundSystemic lupus erythematosus (SLE) patients often suffer hand function limitations even in the absence of symptoms related to joint or tendon disorders. Recent researches reported the presence of ultrasonographic (US) subclinical synovitis and tendon involvement in asymptomatic patients. We aimed to assess US patterns in SLE patients and determine their relationship with clinical assessment, disease activity and hand functional status using handheld dynamometry.ResultsWe assessed 30 SLE patients (60 hands) using US; 21 (70%) patient had synovial hypertrophy, 8 (26%) showed a power Doppler (PD) activity, 6 (20%) had erosions and 11 (36.6%) had tendon US abnormality. Both patients with hand arthralgia/arthritis (symptomatic) and patients without arthralgia/arthritis (asymptomatic) had a statistically insignificant difference regarding the global synovitis score (p = 0.2) and disease activity (p = 0.3). However, the symptomatic group had a significantly increased number of joints with effusion (p = 0.04) and tendons involved (p = 0.04). The mean grip strength had a significant negative correlation with SLEDAI-2 K score (rs = − 0.4, p = 0.02) in the total patient group. In the asymptomatic group, a negative correlation was found between both mean grip (rs = − 0.5, p = 0.04) and pinch strength (rs = − 0.6, p = 0.01) with PD index, and mean pinch strength with the Jaccoud’s arthropathy index (rs = − 0.49, p = 0.05).ConclusionsSLE patients may have higher subclinical synovitis, erosions and tendon involvement than expected, which may in turn reduce hand grip and pinch strength. Disease activity may also have a negative impact on the hand grip functional strength.

Highlights

Systemic lupus erythematosus (SLE) patients often suffer hand function limitations even in the absence of symptoms related to joint or tendon disorders
We assessed US patterns in SLE patients and determined their relationship with clinical assessment, disease activity and hand functional status using handheld dynamometry. This cross-sectional study was conducted on 30 female patients with SLE fulfilling the Systemic Lupus Collaborating Clinics (SLICC) [12] criteria with age more than 18 and less than 65 years old. They were recruited from our Rheumatology and Rehabilitation outpatient clinic serving as a tertiary referral centre over a period of 1 year
History of arthralgia was present in 73.3%, arthritis in 16.7% and morning stiffness (MS) in 40% of patients

Summary

Introduction

Systemic lupus erythematosus (SLE) patients often suffer hand function limitations even in the absence of symptoms related to joint or tendon disorders. Recent researches reported the presence of ultrasonographic (US) subclinical synovitis and tendon involvement in asymptomatic patients. Some authors have reported subclinical ultrasonographic (US) synovitis in asymptomatic SLE patients with a high percentage of tendon involvement [8,9,10]. Piga et al in 2016 [11] found that baseline power Doppler (PD) synovitis score predicted MSK flare within 2 years from US examination This may help physicians in detecting subclinical joint affection in the early phase of window of opportunity, optimizing medical treatment and suspecting Rhupus patients who display more aggressive MSK involvement

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