The Modified Hand Mobility in Scleroderma Test and Skin Involvement - A Followup Study

Objective. To study the change in the modified Hand Mobility in Scleroderma ( mHAMIS) test from early to advanced stages of systemic sclerosis ( SSc), and the relationship between mHAMIS and skin involvement during followup. Methods. This retrospective study includes 65 patients with baseline disease duration of <= 3 years who were assessed with the mHAMIS test at baseline and at 1 or 2 predefined followup points ( 3.1-5 yrs and 5.1-9 yrs after disease onset). Studied measures were the modified Rodnan skin score ( mRSS), mRSS of the hand, serum cartilage oligomeric matrix protein, and digital vascular lesions. Results. The mHAMIS and the mRSS hand changed synchronously during the first 5 years after disease onset ( r(s) = 0.44, p = 0.001). In the group with high mHAMIS at baseline, both mHAMIS and mRSS hand improved significantly at the first followup ( p < 0.05), and the improvement sustained during the followup in the mRSS hand. Patients with antitopoisomerase I and anti-RNA polymerase III antibodies had significantly higher mHAMIS at baseline ( p = 0.003) and at the second followup ( p = 0.030) compared to patients with anticentromere antibodies. Patients with digital vascular lesions at baseline had significantly higher mHAMIS during the followup ( p < 0.05) compared to patients without. The mHAMIS improved significantly during the followup in patients with immunosuppressive treatment in early disease ( p < 0.05), but not in patients without this treatment. Conclusion. The mHAMIS reflects disease activity in fibrosis in early stages of SSc. In later stages it can be regarded as a measure of damage arising from fibrotic and vascular involvement, making it suitable as an endpoint in followup examinations.