ObjectiveTo assess the effect of upper limb exercise on hand function, daily activities performance and quality of life of patients with systemic lupus erythematosus (SLE).MethodsWe performed a pilot randomised, 24-week follow-up, unmasked controlled trial. Inclusion criteria were upper limb arthralgias, a Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score >10 and a stable treatment over the past 3 months. Patients were randomly allocated in the routine care (control) or exercise group that received an individually tailored 30-min daily upper-limb exercise programme by a hand therapist for 12 weeks. We evaluated at 0, 6, 12 and 24 weeks the performance of daily activities for both groups with DASH questionnaire and Health Assessment Questionnaire (HAQ), the grip and pinch strength with Jamar dynamometer and pinch gauge tool, respectively, the dexterity with Purdue pegboard test, the quality of life with Lupus Quality of Life (LupusQoL) Questionnaire and the pain level by Visual Analogue Scale (VAS) score.ResultsFrom 293 consecutive SLE patients, data from 32 patients allocated to the exercise group and 30 to the control group were analysed. There was a significant difference between the two groups in percentage changes of DASH, HAQ, grip strength, pinch strength, LupusQoL-physical health and fatigue, and VAS scores from baseline to 6, 12 and 24 weeks, and from baseline to 12 weeks for dexterity test (p<0.001). No interaction was observed between exercise and disease activity or medication use at baseline and during the observation period.ConclusionUpper-limb exercise significantly improves hand function, pain, daily activity performance and quality of life in SLE.Trial registration numberNCT03802578.

Objective The Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) was developed to assess health deficits including disease activity, organ damage, comorbidities and functional status. We examined any relationship between SLICC-FI and objective physical function measures, activities of daily living (ADL) performance, and quality of life in Systemic Lupus Erythematosus (SLE). Methods SLICC-FI was estimated using data from patient files and patient-reported questionnaires. Jamar Dynamometer, pinch gauge and Purdue pegboard test measured grip strength, pinch strength and dexterity, respectively. ADL performance was assessed by the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, and Health Assessment Questionnaire (HAQ). Quality of life was evaluated by LupusQol questionnaire. Results This cross-sectional study included 240 SLE patients (90% female, mean (SD) age: 47.63 (13.01), median (IQR) disease duration: 9 (4-16). Mean (SD) SLICC-FI was 0.09 (0.06). Forty-three (17.9%) patients were classified as robust, 105 (43.8%) as relatively less fit, 77 (32.1%) as least fit, and 15 (6.2%) as frail. In univariate analysis, SLICC-FI was significantly associated with DASH and HAQ with an inverse association with grip strength, pinch strength, and all purdue scores (all p &lt; 0.001). A negative correlation was found between SLICC-FI score and all LupusQoL domain scores (all p &lt; 0.001). All associations remained statistically significant in multivariate regression analysis, after adjustment for age, disease duration, SLEDAI-2K, SLICC, immunosuppressives, corticosteroids and Charlson score. Conclusion SLICC-FI is independently associated with poor physical function and ADL performance and impaired quality of life and may help to identify patients in need for additional interventions beyond routine care.

Objective To examine hand function and performance in activities of daily living (ADL) in patients with systemic lupus erythematosus (SLE) vs healthy controls, and any associations with demographic and disease–related characteristics. Methods Hand function (grip strength, pinch strength, dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and gender-matched healthy controls. Grip strength, pinch strength, and dexterity were measured by Jamar dynamometer, pinch gauge, and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by Disabilities of the Arm, Shoulder and Hand (DASH) and Health Assessment Questionnaire (HAQ). Regression analysis was performed to assess the determinants of hand dysfunction. Results All hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS) (n = 157) compared to healthy subjects (p &lt; 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ and immunosuppressives use with DASH, HAQ and grip strength. Similarly, in patients in LLDAS, painful joints correlated with DASH and HAQ, age with grip strength and Purdue (p &lt; 0.001), gender with grip strength and immunosuppressives with HAQ and grip strength. Conclusion Hand function and daily activities performance are significantly impaired in SLE, even in patients who achieved LLDAS, suggesting the need for their evaluation and management in clinical practice.