Objective Millions of patients suffer from the disabling hand manifestations of rheumatoid arthritis (RA), yet few hand-specific instruments are validated in this population. Our objective is to assess the reliability, validity, and responsiveness of the Michigan Hand Questionnaire (MHQ) in RA patients. Methods At enrollment and at 6 months, 128 RA patients with severe subluxation of the metacarpophalangeal joints completed the MHQ, a 37-item questionnaire with 6 domains: function, activities of daily living (ADL), pain, work, aesthetics, and satisfaction. Reliability was measured using Spearman correlation coefficients (r) between time periods. Internal consistency was measured using Cronbach’s α. Construct validity was measured by correlating MHQ responses with the Arthritis Impact Measurement Scale 2 (AIMS2). Responsiveness was measured by calculating standardized response means between time periods. Results The MHQ demonstrated good test-retest reliability (r = 0.66, p<0.001). Cronbach’s α scores were high for ADL (α=0.90), function (α=0.87), aesthetics (α=0.79), and satisfaction (α=0.89), indicating redundancy. The MHQ correlated well with AIMS2 responses. Function (r=−0.63), ADL (r=−0.77), work (r=−0.64), pain (r=0.59), and summary score (r=−0.74) were correlated with the physical domain. Affect was correlated with ADL (r=−0.47), work (r=−0.47), pain (r=0.48), and summary score (r=−0.53). Responsiveness was excellent among arthroplasty patients: function (SRM=1.42), ADL (SRM=0.89), aesthetics (SRM=1.23), satisfaction (SRM=1.76), and summary score (SRM=1.61). Conclusions The MHQ is easily administered, reliable and valid to measure rheumatoid hand function, and can be used to measure outcomes in rheumatoid hand disease.

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Purpose Metacarpophalangeal (MCP) joint deformities caused by rheumatoid arthritis can be treated using silicone metacarpophalangeal joint arthroplasty (SMPA). There is no consensus whether this surgical procedure is beneficial. The purpose of the study was to prospectively compare outcomes for a surgical and a non-surgical cohort of rheumatoid arthritis patients. Methods The prospective cohort trial was conducted from January 2004 to May 2008 at 3 referral centers in the US and England. Over a 3 year period, 70 surgical and 93 nonsurgical patients were recruited. One year data are available for 45 cases and 72 controls. All patients had severe ulnar drift and/or extensor lag of the fingers at the MCP joints. The patients all had one year follow-up evaluations. Patients could elect to undergo SMPA and medical therapy or medical therapy alone. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales (AIMS2), grip/pinch strength, Jebson-Taylor test and ulnar deviation and extensor lag measurements at the MCP joints. Results There was no difference in the mean age for the surgical group (60) when compared to the non-surgical group (62). There was also no significant difference in race, education, and income between the two groups. At one year follow-up time, the mean overall MHQ score showed significant improvement in the surgical group, but no change in the non-surgical group, despite worse MHQ function at baseline in the surgical group. Ulnar deviation and extensor lag improved significantly in the surgical group, but the mean AIMS2 scores and grip/pinch strength showed no significant improvement. Conclusion This clinical trial demonstrated significant improvement for RA patients with poor baseline functioning treated with SMPA. The non-surgical group had better MHQ scores at baseline and their function did not deteriorate during the one year follow-up interval.