Abstract
BackgroundThe presence of “mechanic’s hands” is one of the clinical clues for collagen vascular diseases. However, the exact relevance of “mechanic’s hands” in collagen vascular diseases has not been well documented. The aim of this study was to clarify the relevance of “mechanic’s hands” to collagen vascular diseases including various skin lesions and interstitial pneumonia.MethodsA retrospective review of the medical records of patients with “mechanic’s hands” at our hospital between April 2011 and December 2012 was conducted. A PubMed search was also conducted using the term “mechanic’s hands”.ResultsFour patients in our institution and 40 patients obtained from PubMed who had “mechanic’s hands” were identified. The most frequent diseases were DM/amyopathic DM (n = 24, 54.5%) and anti-ARS syndrome (n = 17, 38.6%). In these patients, the major skin lesions associated with “mechanic’s hands” were periungual erythema (n = 23, 52.3%), Gottron’s sign (n = 17, 38.6%), heliotrope rash (n = 10, 22.7%), Raynaud’s phenomenon (n = 9, 20.5%), and anti-ARS syndrome (n = 17, 38.6%). Six cases (2 DM, 4 anti-ARS syndrome) had only “mechanic’s hands”. Antibodies to anti-ARS (n = 24) were Jo-1 (n = 19), PL-7 (n = 3), OJ (n = 1), and PL-12 (n = 1).ConclusionThe presence of “mechanic’s hands” together with diverse skin lesions could be a clinical clue to the diagnosis of lung involvement associated with collagen vascular diseases, especially in anti-ARS syndrome or DM/amyopathic DM.
Highlights
The presence of “mechanic’s hands” is one of the clinical clues for collagen vascular diseases
Patients who presented to the Kyorin University School of Medicine (Mitaka City, Tokyo, Japan) who were consecutively admitted to the Department of Respiratory Medicine with “mechanic’s hands” based on the criteria of Stahl et al were investigated [1]
Patients who satisfied the criteria for inflammatory myositis, polymyositis, and dermatomyositis proposed by Bohan and Peter’s [2] and Tanimoto et al [3], respectively, were enrolled
Summary
The presence of “mechanic’s hands” is one of the clinical clues for collagen vascular diseases. The exact relevance of “mechanic’s hands” in collagen vascular diseases has not been well documented. The aim of this study was to clarify the relevance of “mechanic’s hands” to collagen vascular diseases including various skin lesions and interstitial pneumonia. In 1979, Stahl et al [1] described “mechanic’s hands” as a hyperkeratotic eruption on the ulnar aspect of the thumb and radial aspect of the index finger, with desquamation and rhagades. The presence of “mechanic’s hands” has been reported to be highly relevant in patients with collagen vascular-related interstitial pneumonia, dermatomyositis, systemic lupus erythematosus, and mixed connective tissue disease. Anti-ARS syndrome has emerged as a new clinical entity
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