Hand Function in Scleroderma

  • Angela Del RossoEmail author
  • Susanna Maddali-Bongi
  • Marco Matucci-Cerinic


Systemic sclerosis or scleroderma (SSc) is characterized by immunologic abnormalities, microvascular alterations, and excessive collagen production, leading to fibrosis of skin and internal organs (lungs, heart, gastrointestinal tract).

Hands are prominent targets of SSc and may be involved at different levels. Frequent signs and symptoms of the disease, such as skin and microcirculatory impairment as well as musculoskeletal involvement (of joints, tendons, and muscles), usually begin from the hands. Hand involvement evolves throughout all the course of the disease and leads to important disability in SSc.

This chapter analyzes the involvement of the hands in SSc, focusing on the causes and the kind of functional disturbances; relation between hand impairment and other clinical parameters; hand function in different stages of the disease; and tools to assess damage and function of the hand.


Work Ability Grip Force Flexion Contracture Digital Ulcer Global Disability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wigley FM. Systemic sclerosis: clinical features. In: Klippel JH, Dieppe PA, editors. Rheumatology. Philadelphia: Mosby; 1998. p. 7.9.1.Google Scholar
  2. 2.
    Poole JL. Grasp pattern variations seen in the scleroderma hand. Am J Occup Ther. 1994;48(1):46–54.PubMedGoogle Scholar
  3. 3.
    Maddali-Bongi S, Del Rosso A, Passalacqua M, Miccio S, Matucci-Cerinic M. Manual lymph drainage improves upper limb oedema and hand function in patients with systemic sclerosis (SSc) in oedematous phase. Arthritis Care Res. 2011;63:1134–41.Google Scholar
  4. 4.
    Khanna PP, Furst DE, Clements PJ, et al. Tendon friction rubs in early diffuse systemic sclerosis: prevalence, characteristics and longitudinal changes in a randomized controlled trial. Rheumatology (Oxford). 2010;49:955–9.Google Scholar
  5. 5.
    Entin MA, Wilkinson RD. Scleroderma hand: a reappraisal. Orthop Clin North Am. 1973;4:1031–8.PubMedGoogle Scholar
  6. 6.
    Palmer DC, Hale GM, Grennan DM, et al. Bowed fingers: a helpful sign in the early diagnosis of systemic sclerosis. J Rheumatol. 1981;8:266–72.PubMedGoogle Scholar
  7. 7.
    Bandinelli F, Kaloudi O, Candelieri A, et al. Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients. Clin Exp Rheumatol. 2010;28(5 Suppl 62):S15–8.PubMedGoogle Scholar
  8. 8.
    Czirják L, Foeldvari I, Müller-Ladner U. Skin involvement in systemic sclerosis. Rheumatology (Oxford). 2008;47 Suppl 5:v44–5.Google Scholar
  9. 9.
    Clements PJ, Lachenbrunch PA, Seibold JR, et al. Skin thickness score in systemic sclerosis: an assessment of interobserver variability in 3 independent studies. J Rheumatol. 1993;20:1892–6.PubMedGoogle Scholar
  10. 10.
    Verrechia F, Laboureau J, Verola O, et al. Skin involvement in scleroderma—where histological and clinical scores meet. Rheumatology. 2007;46:833–41.Google Scholar
  11. 11.
    Kissin EY, Schiller AM, Gelbard RB, et al. Durometry for the assessment of skin disease in systemic sclerosis. Arthritis Rheum. 2006;55:603–9.PubMedGoogle Scholar
  12. 12.
    Merkel PA, Silliman NP, Denton CP, et al. for the CAT-192 Research Group and the Scleroderma Clinical Trials Consortium. Validity, reliability, and feasibility of durometer measurements of scleroderma skin disease in a multicenter treatment trial. Arthritis Rheum. 2008;59:699–705.Google Scholar
  13. 13.
    Kaloudi O, Bandinelli F, Filippucci E, et al. High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis. Ann Rheum Dis. 2010;69:1140–3.PubMedGoogle Scholar
  14. 14.
    Iagnocco A, Kaloudi O, Perella C, et al. Ultrasound elastography assessment of skin involvement in systemic sclerosis: lights and shadows. J Rheumatol. 2010;37:1688–91.PubMedGoogle Scholar
  15. 15.
    Bonél H, Messer G, Seemann M, et al. MRI of fingers in systemic scleroderma. Initial results with contrast-enhanced studies using a dedicated MRI system. Radiologe. 1997;37:794–801.PubMedGoogle Scholar
  16. 16.
    Resnick D. Scleroderma (progressive systemic sclerosis). In: Resnick D, editor. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: Saunders; 1995. p. 1191–217.Google Scholar
  17. 17.
    Avouac J, Guerini H, Wipff J, et al. Radiological hand involvement in systemic sclerosis. Ann Rheum Dis. 2006;65:1088–92.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Tuffanelli DL, Winkelmann RK. Systemic scleroderma: a clinical study of 727 cases. Arch Dermatol. 1961;84:359–71.PubMedGoogle Scholar
  19. 19.
    Baron M, Lee P, Keistone EC. The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis. 1982;41:147–52.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Erre GL, Marongiu A, Fenu P, et al. The “sclerodermic hand”: a radiological and clinical study. Joint Bone Spine. 2008;75:426–31.PubMedGoogle Scholar
  21. 21.
    Blocka K, Bassett LW, Furst DE, et al. The arthropathy of advanced of progressive systemic sclerosis. Arthritis Rheum. 1981;24:874–84.PubMedGoogle Scholar
  22. 22.
    Ashida R, Ihn H, Mimura Y, et al. Clinical features of scleroderma patients with contracture of phalanges. Clin Rheumatol. 2007;26:1275–7.PubMedGoogle Scholar
  23. 23.
    Brower LM, Poole JL. Reliability and validity of the Duruöz hand index in person with systemic sclerosis (scleroderma). Arthritis Rheum. 2004;51:805–9.PubMedGoogle Scholar
  24. 24.
    Maddali-Bongi S, Del Rosso A, Galluccio F, et al. Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis. Clin Rheumatol. 2009;28:1167–73.Google Scholar
  25. 25.
    Sandqvist G, Hesselstrand R, Eberhardt K. A longitudinal follow-up of hand involvement and activities of daily living in early systemic sclerosis. Scand J Rheumatol. 2009;38:304–10.PubMedGoogle Scholar
  26. 26.
    Sandqvist G, Scheja A, Hesselstrand R. Pain, fatigue and hand function closely correlated to work ability and employment status in systemic sclerosis. Rheumatology (Oxford). 2010;49:1739–46.Google Scholar
  27. 27.
    Misra R, Darton K, Jewkes RF, Black CM, Maini RN. Arthritis in scleroderma. Br J Rheumatol. 1995;34:831–7.PubMedGoogle Scholar
  28. 28.
    Pope JE. Musculoskeletal involvement in scleroderma. Rheum Dis Clin N Am. 2003;29:391–408.Google Scholar
  29. 29.
    Ostojic P, Damjanov N. Different clinical features in patients with limited and diffuse cutaneous systemic sclerosis. Clin Rheumatol. 2006;25:453–7.PubMedGoogle Scholar
  30. 30.
    Tate G, Schumacher HR. Bone and articular involvement on systemic sclerosis (scleroderma). In: Jayson MIV, Black CM, editors. Systemic sclerosis (scleroderma). New York: Wiley; 1988. p. 247–57.Google Scholar
  31. 31.
    Catoggio LJ, Evison G, Harkness JAL, Maddison PJ. The arthropathy of systemic sclerosis (scleroderma): comparison with mixed connective tissue disease. Clin Exp Rheumatol. 1983;1:101–12.PubMedGoogle Scholar
  32. 32.
    Zimmermann C, Steiner G, Skriner K, Hassfeld W, Petera P, Smolen JS. The concurrence of rheumatoid arthritis and limited systemic sclerosis. Arthritis Rheum. 1998;41:1938–45.PubMedGoogle Scholar
  33. 33.
    Boutry N, Hachulla E, Zanetti-Musielak C, et al. Imaging features of musculoskeletal involvement in systemic sclerosis. Eur Radiol. 2007;17:1172–80.PubMedGoogle Scholar
  34. 34.
    La Montagna G, Sodano A, Capurro V, et al. The arthropathy of systemic sclerosis: a 12 month prospective clinical and imaging study. Skeletal Radiol. 2005;34:35–41.PubMedGoogle Scholar
  35. 35.
    Brun B, Serup J, Hagdrup H. Radiological changes of the hands in systemic sclerosis. Acta Derm Venereol. 1983;63:349–52.PubMedGoogle Scholar
  36. 36.
    Cuomo G, Zappia M, Abignano G, et al. Ultrasonographic features of the hand and wrist in systemic sclerosis. Rheumatology (Oxford). 2009;48:1414–7.Google Scholar
  37. 37.
    Chitale S, Ciapetti A, Hodgson R, et al. Magnetic resonance imaging and musculoskeletal ultrasonography detect and characterize covert inflammatory arthropathy in systemic sclerosis patients with arthralgia. Rheumatology (Oxford). 2010;49:2357–61.Google Scholar
  38. 38.
    Low AH, Lax M, Johnson SR, Lee P. Magnetic resonance imaging of the hand in systemic sclerosis. J Rheumatol. 2009;36:961–4.PubMedGoogle Scholar
  39. 39.
    Rodnan GP, Medsger TA. The rheumatic manifestation of progressive systemic sclerosis (scleroderma). Clin Orthop Relat Res. 1968;57:81–93.PubMedGoogle Scholar
  40. 40.
    Jimenez SA, Derk C. Following the molecular pathways toward an understanding of the pathogenesis of systemic sclerosis. Ann Intern Med. 2004;140:37–50.PubMedGoogle Scholar
  41. 41.
    Steen VD, Medsger TA. The palpable tendon friction rub. Arthritis Rheum. 1997;40:1146–51.PubMedGoogle Scholar
  42. 42.
    Clements PJ, Furst DE, Campion DS, et al. Muscle disease in progressive systemic sclerosis: diagnostic and therapeutic considerations. Arthritis Rheum. 1978;21:62–71.PubMedGoogle Scholar
  43. 43.
    De Angelis R, Grassi W, Cutolo M. A growing need for capillaroscopy in rheumatology. Arthritis Rheum. 2009;15(61):405–10.Google Scholar
  44. 44.
    Sunderkötter C, Riemekasten G. Pathophysiology and clinical consequences of Raynaud’s phenomenon related to systemic sclerosis. Rheumatology (Oxford). 2006;45 Suppl 3:iii33–5.Google Scholar
  45. 45.
    Hasegawa M, Nagai Y, Tamura A, Ishikawa O. Arteriographic evaluation of vascular changes of the extremities in patients with systemic sclerosis. Br J Dermatol. 2006;155:1159–64.PubMedGoogle Scholar
  46. 46.
    Ferri C, Valentini G, Cozzi F, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine. 2002;81:139–53.PubMedGoogle Scholar
  47. 47.
    Block JA, Sequeira W. Raynaud’s phenomenon. Lancet. 2001;357:2042–8.PubMedGoogle Scholar
  48. 48.
    Denton CP, Korn JH. Digital ulceration and critical digital ischaemia in scleroderma. Scleroderma Care Res. 2003;1:12–6.Google Scholar
  49. 49.
    Wigley FM, Korn JH, Csuka ME, et al. Oral iloprost treatment in patients with Raynaud phenomenon secondary to systemic sclerosis. Arthritis Rheum. 1998;41:670–7.PubMedGoogle Scholar
  50. 50.
    Pope JE, Bellamy N. Sample size calculations in scleroderma: a rational approach to choosing outcome measurements in scleroderma trials. Clin Invest Med. 1995;18:1–10.PubMedGoogle Scholar
  51. 51.
    Hachulla E, Clerson P, Launay D, et al. Natural history of ischemic digital ulcers in systemic sclerosis: single-center retrospective longitudinal study. J Rheumatol. 2007;34:2423–30.PubMedGoogle Scholar
  52. 52.
    Walker UA, Tyndall A, Czirják L, et al. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2007;66:754–63.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Amanzi L, Braschi F, Fiori G, et al. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford). 2010;49:1374–82.Google Scholar
  54. 54.
    Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology (Oxford). 2009;48 Suppl 3:iii19–24.Google Scholar
  55. 55.
    Mouthon L, Mestre-Stanislas C, Bérezné A, et al. Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis. Ann Rheum Dis. 2010;69:214–7.PubMedGoogle Scholar
  56. 56.
    Korn JH. Scleroderma: a treatable disease. Cleve Clin J Med. 2003;70:954–68.PubMedGoogle Scholar
  57. 57.
    Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis. 2008;67:120–3.PubMedGoogle Scholar
  58. 58.
    Grassi W, De Angelis R. Capillaroscopy: questions and answers. Clin Rheumatol. 2007;26:2009–16.PubMedGoogle Scholar
  59. 59.
    Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27:155–60.PubMedGoogle Scholar
  60. 60.
    Murray AK, Moore TL, King TA, Herrick AL. Abnormal microvascular response is localized to the digits in patients with systemic sclerosis. Arthritis Rheum. 2006;54:1952–60.PubMedGoogle Scholar
  61. 61.
    Murray AK, Moore TL, Manning JB, et al. Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders. Arthritis Rheum. 2009;61:1103–11.PubMedGoogle Scholar
  62. 62.
    Gunawardena H, Harris ND, Carmichael C, McHugh NJ. Maximum blood flow and microvascular regulatory responses in systemic sclerosis. Rheumatology (Oxford). 2007;46:1079–82.Google Scholar
  63. 63.
    Kim SH, Kim HO, Jeong YG, et al. The diagnostic accuracy of power Doppler ultrasonography for differentiating secondary from primary Raynaud’s phenomenon in undifferentiated connective tissue disease. Clin Rheumatol. 2008;27:408–11.Google Scholar
  64. 64.
    Janevski B. Arteries of the hand in patients with scleroderma. Diagn Imaging Clin Med. 1986;55:262–5.PubMedGoogle Scholar
  65. 65.
    Dabich L, Bookstein JJ, Zweifler A, Zarafonetis CJ. Digital arteries in patients with scleroderma: arteriographic and plethysmographic study. Arch Intern Med. 1972;130:708–14.PubMedGoogle Scholar
  66. 66.
    Allanore Y, Seror R, Chevrot A, Kahan A, Drapé JL. Hand vascular involvement assessed by magnetic resonance angiography in systemic sclerosis. Arthritis Rheum. 2007;56:2747–54.PubMedGoogle Scholar
  67. 67.
    Matucci Cerinic M, Generini S, Pignone A, Casale R. The nervous system in systemic sclerosis (scleroderma). Clinical features and pathogenetic mechanisms. Rheum Dis Clin North Am. 1996;22:879–92.Google Scholar
  68. 68.
    Lori S, Matucci-Cerinic M, Casale R, et al. Peripheral nervous system involvement in systemic sclerosis: the median nerve as target structure. Clin Exp Rheumatol. 1996;14:601–5.PubMedGoogle Scholar
  69. 69.
    Casale R, Buonocore M, Matucci-Cerinic M. Systemic sclerosis (scleroderma): an integrated challenge in rehabilitation. Arch Phys Med Rehabil. 1997;78:767–73.PubMedGoogle Scholar
  70. 70.
    Mondelli M, Romano C, De Stefano R, Cioni R. Nerve conduction velocity study of the upper limb in Raynaud’s phenomenon. Rheumatol Int. 2000;19:165–9.PubMedGoogle Scholar
  71. 71.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.PubMedGoogle Scholar
  72. 72.
    Bassel M, Hudson M, Taillefer SS, et al. Frequency and impact of symptoms experienced by patients with systemic sclerosis: results from a Canadian National Survey. Rheumatology (Oxford). 2011;50:762–7.Google Scholar
  73. 73.
    van Lankveld WG, Vonk MC, Teunissen H, van den Hoogen FH. Appearance self-esteem in systemic sclerosis—subjective experience of skin deformity and its relationship with physician-assessed skin involvement, disease status and psychological variables. Rheumatology. 2007;46:8726.Google Scholar
  74. 74.
    Richards H, Herrick A, Griffin K, Gwilliam P, Fortune D. Psychological adjustment to systemic sclerosis exploring the association of disease factors, functional ability, body related attitudes and fear of negative evaluation. Psychol Health Med. 2004;9:2939.Google Scholar
  75. 75.
    Sandqvist G, Eklund M, Akesson A, Nordenskiöld U. Daily activities and hand function in women with scleroderma. Scand J Rheumatol. 2004;33:102–7.PubMedGoogle Scholar
  76. 76.
    Sandqvist G, Scheja A, Eklund M. Working ability in relation to disease severity, everyday occupations and well-being in women with limited systemic sclerosis. Rheumatology (Oxford). 2008;47:1708–11.Google Scholar
  77. 77.
    Bérezné A, Seror R, Morell-Dubois S, et al. Impact of systemic sclerosis on occupational and professional activity with attention to patients with digital ulcers. Arthritis Care Res (Hoboken). 2011;63:277–85.Google Scholar
  78. 78.
    Avouac J, Mogavero G, Guerini H, et al. Predictive factors of hand radiographic lesions in systemic sclerosis: a prospective study. Ann Rheum Dis. 2011;70:630–3.PubMedGoogle Scholar
  79. 79.
    Medsger TA, Rodnan GP, Moosy J, et al. Skeletal muscle involvement in progressive systemic sclerosis (scleroderma). Arthritis Rheum. 1968;11:554–68.PubMedGoogle Scholar
  80. 80.
    Follansbee W, Zerbe T, Medsger TA. Cardiac and skeletal muscle disease in systemic sclerosis (scleroderma): a high risk association. Am Heart J. 1993;125:194–203.PubMedGoogle Scholar
  81. 81.
    West SG, Killan PJ, Lawless OJ. Association of myositis and myocarditis in progressive systemic sclerosis. Arthritis Rheum. 1981;24:662–7.PubMedGoogle Scholar
  82. 82.
    Tiev KP, Diot E, Clerson P, et al. Clinical features of scleroderma patients with or without prior or current ischemic digital ulcers: post-hoc analysis of a nationwide multicenter cohort (ItinerAIR-Sclerodermie). J Rheumatol. 2009;36:1470–6.PubMedGoogle Scholar
  83. 83.
    Sunderkotter C, Herrgott I, Bruckner C, et al. Comparison of patients with and without digital ulcers in systemic sclerosis: detection of possible risk factors. Br J Dermatol. 2009;160:835–43.PubMedGoogle Scholar
  84. 84.
    Poole JL, Steen VD. The use of the HAQ to determine physical disability in SSc. Arthritis Care Res. 1991;4:27–31.PubMedGoogle Scholar
  85. 85.
    Steen VD, Medsger TA. The value of the HAQ and special patient generated scales to demonstrate change in SSc patients over time. Arthritis Rheum. 1997;40:1984–91.PubMedGoogle Scholar
  86. 86.
    Johnson SR, Hawker GA, Davis AM. The health assessment questionnaire disability index and scleroderma health assessment questionnaire in scleroderma trials: an evaluation of their measurement properties. Arthritis Rheum. 2005;53:256–62.PubMedGoogle Scholar
  87. 87.
    Ruof J, Brühlmann P, Michel BA, Stucki G. Development and validation of a self-administered systemic sclerosis questionnaire (SySQ). Rheumatology (Oxford). 1999;38:535–42.Google Scholar
  88. 88.
    Ostojić P, Damjanov N. The scleroderma assessment questionnaire (SAQ). A new self-assessment questionnaire for evaluation of disease status in patients with systemic sclerosis. Z Rheumatol. 2006;65:168–75.PubMedGoogle Scholar
  89. 89.
    Ostojic P, Damjanov N. Indices of the scleroderma assessment questionnaire (SAQ) can be used to demonstrate change in patients with systemic sclerosis over time. Joint Bone Spine. 2008;75:286–90.PubMedGoogle Scholar
  90. 90.
    Kallen MA, Mayes MD, Kriseman YL, et al. The symptom burden index: development and initial findings from use with patients with systemic sclerosis. J Rheumatol. 2010;37:1692–8.PubMedGoogle Scholar
  91. 91.
    Duruöz MT, Poiraudeau S, Fermanian J, et al. Development and validation of a rheumatoid Duruöz’s hand index that assesses functional handicap. J Rheumatol. 1996;23:1167–72.PubMedGoogle Scholar
  92. 92.
    Poiraudeau S, Chevalier X, Conrozier T, et al. Reliability, validity, and sensitivity to change of the Cochin Duruöz’s hand index in hand osteoarthritis. Osteoarthr Cartil. 2001;9:570–7.PubMedGoogle Scholar
  93. 93.
    Brower LM, Poole JL. Reliability and validity of the Duruöz hand index in persons with systemic sclerosis (scleroderma). Arthritis Rheum. 2004;51:805–9.PubMedGoogle Scholar
  94. 94.
    Rannou F, Poiraudeau S, Berezne A, et al. Assessing disability and quality of life in systemic sclerosis: construct validities of the Cochin hand function scale, health assessment questionnaire (HAQ), systemic sclerosis HAQ, and medical outcomes study 36-item short form health survey. Arthritis Rheum. 2007;57:94–102.PubMedGoogle Scholar
  95. 95.
    Ingegnoli F, Galbiati V, Boracchi P, et al. Reliability and validity of the Italian version of the hand functional disability scale in patients with systemic sclerosis. Clin Rheumatol. 2008;27:743–9.PubMedGoogle Scholar
  96. 96.
    Backman C, Mackie H. Arthritis hand function test manual. Vancouver: University of British Columbia; 1997.Google Scholar
  97. 97.
    Poole JL, Gallegos M, O’Linc S. Reliability and validity of the Arthritis Hand Function Test in adults with systemic sclerosis (scleroderma). Arthritis Care Res. 2000;13:69–73.PubMedGoogle Scholar
  98. 98.
    Varjú C, Bálint Z, Solyom AI, et al. Cross-cultural adaptation of the disabilities of the arm, shoulder, and hand (DASH) questionnaire into Hungarian and investigation of its validity in patients with systemic sclerosis. Clin Exp Rheumatol. 2008;26:776–83.PubMedGoogle Scholar
  99. 99.
    Penta M, Thonnard JL, Tesio L. ABILHAND: a Rasch-built measure of manual ability. Arch Phys Med Rehabil. 1998;79:1038–42.PubMedGoogle Scholar
  100. 100.
    Vanthuyne M, Smith V, Arat S, et al. Validation of a manual ability questionnaire in patients with systemic sclerosis. Arthritis Rheum. 2009;61:695–703.PubMedGoogle Scholar
  101. 101.
    Silman A, Akesson A, Newman J, et al. Assessment of functional ability in patients with scleroderma: a proposed new disability assessment instrument. J Rheumatol. 1998;25:79–83.PubMedGoogle Scholar
  102. 102.
    Smyth AE, MacGregor AJ, Mukerjee D, et al. A cross sectional comparison of three self-reported functional indices in scleroderma. Rheumatology. 2003;42:732–8.PubMedGoogle Scholar
  103. 103.
    Serednicka K, Smyth AE, Black CM, Denton CP. Using a self-reported functional score to assess disease progression in systemic sclerosis. Rheumatology (Oxford). 2007;46:1107–10.Google Scholar
  104. 104.
    Sandqvist G, Eklund M. Hand mobility in scleroderma (HAMIS) test: the reliability of a novel hand function test. Arthritis Care Res. 2000;13:369–74.PubMedGoogle Scholar
  105. 105.
    Sandqvist G, Eklund M. Validity of HAMIS: a test of hand mobility in scleroderma. Arthritis Care Res. 2000;13:382–7.PubMedGoogle Scholar
  106. 106.
    Del Rosso A, Maddali-Bongi S, Sigismondi F, et al. The Italian version of the hand mobility in scleroderma (HAMIS) test: evidence for its validity and reliability. Clin Exp Rheumatol. 2010;28(5 Suppl 62):S42–7.PubMedGoogle Scholar
  107. 107.
    Ingegnoli F, Boracchi P, Ambrogi F, et al. Hand impairment in systemic sclerosis: association of different hand indices with organ involvement. Scand J Rheumatol. 2010;39:393–7.PubMedGoogle Scholar
  108. 108.
    Maddali Bongi S, Del Rosso A, Galluccio F, et al. Efficacy of a tailored rehabilitation program for systemic sclerosis. Clin Exp Rheumatol. 2009;27(3 Suppl 54):44–50.PubMedGoogle Scholar
  109. 109.
    Furst DE, Clements PJ, Hasrris R, et al. Measurement of clinical change in progressive systemic sclerosis: a 1 year double-blind placebo-controlled trial of N-acetylcysteine. Ann Rheum Dis. 1979;38:356–61.PubMedCentralPubMedGoogle Scholar
  110. 110.
    Merkel PA, Clements PJ, Reveille JD, et al. Current status of outcome measure development for clinical trials in systemic sclerosis. Report from OMERACT 6. J Rheumatol. 2003;30:1630–47.PubMedGoogle Scholar
  111. 111.
    Torok KS, Baker NA, Lucas M, et al. Reliability and validity of the delta finger-to-palm (FTP), a new measure of finger range of motion in systemic sclerosis. Clin Exp Rheumatol. 2010;28(2 Suppl 58):S28–36.PubMedCentralPubMedGoogle Scholar
  112. 112.
    Roberts-Thomson AJ, Massy-Westropp N, Smith MD, et al. The use of the hand anatomic index to assess deformity and impaired function in systemic sclerosis. Rheumatol Int. 2006;26:439–44.PubMedGoogle Scholar
  113. 113.
    Phumethum V, Jamal S, Johnson SR. Biologic therapy for systemic sclerosis: a systematic review. J Rheumatol. 2011;38:289–96.PubMedGoogle Scholar
  114. 114.
    Antonioli CM, Bua G, Frigè A, et al. An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility. Clin Rheumatol. 2009;28:159–65.PubMedGoogle Scholar
  115. 115.
    Mugii N, Hasegawa M, Matsushita T, et al. The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis. J Rheumatol. 2006;33:1586–92.PubMedGoogle Scholar
  116. 116.
    Schouffoer AA, Ninaber MK, Beaart-van de Voorde LJ, et al. A randomised comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis. Arthritis Care Res (Hoboken). 2011;63:909–17.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Angela Del Rosso
    • 1
    Email author
  • Susanna Maddali-Bongi
    • 1
  • Marco Matucci-Cerinic
    • 1
  1. 1.Department of BioMedicine, Division of Rheumatology, Denothe Centre, Careggi Hospital (AOUC)University of FlorenceFlorenceItaly

Personalised recommendations