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.

No abstract

The online version of this article (doi:10.1007/s11552-010-9275-7) contains supplementary material, which is available to authorized users.

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.

Objective Rheumatoid arthritis often results in deformities at the metacarpophalangeal (MCP) joint. Patients with severe deformities can be treated by silicone metacarpophalangeal joint arthroplasty (SMPA). The objective of the study is to prospectively compare long-term outcomes for a SMPA surgical and a non-surgical cohort of rheumatoid arthritis patients. Methods A total of 67 surgical and 95 nonsurgical patients with severe subluxation and/or ulnar drift of the fingers at the MCP joints were recruited from 2004-2008 in this multi-center prospective cohort study. Patients could elect to undergo SMPA or not. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales (AIMS2), grip/pinch strength, Jebson-Taylor test and ulnar deviation, extensor lag and arc of motion measurements at the MCP joints. Results There was no significant difference in the mean age, race, education, and income at baseline between the two groups. Surgical subjects had worse MHQ function and functional measurements at baseline. At 3 years, the mean overall MHQ score and the MHQ function, activities of daily living, aesthetics and satisfaction scores showed significant improvement in the surgical group compared to the non-surgical group. Ulnar deviation, extensor lag and arc of motion in the MCP and PIP joints also improved significantly in the surgical group. No improvement was seen in the mean AIMS2 scores and grip/pinch strength. Complications were minimal with a fracture rate of 9.5%. Conclusion RA patients with poor baseline functioning showed long term improvement in hand function and appearance following treatment with SMPA compared to non-surgical controls.

Background: Current repair options for peripheral nerve injuries where tension-free gap closure is not possible include allograft, processed nerve allograft, and hollow tube conduit. Here we report on the outcomes from a multicenter prospective, randomized, patient-and evaluator-blinded, pilot study comparing processed nerve allograft and hollow conduit for digital nerve reconstructions in the hand. Methods: Across 4 centers, consented participants meeting inclusion criteria while not meeting exclusion criteria were randomized intraoperatively to either processed nerve allograft or hollow conduit. Standard sensory and safety assessments were conducted at baseline, 1, 3, 6, 9, and 12 months after reconstruction. The primary outcome was static 2-point discrimination (s2PD) testing. Participants and assessors were blinded to treatment. The contralateral digit served as the control. Results: We randomized 23 participants with 31 digital nerve injuries. Sixteen participants with 20 repairs had at least 6 months of follow-up while 12-month follow-up was available for 15 repairs. There were no significant differences in participant and baseline characteristics between treatment groups. The predominant nerve injury was laceration/sharp transection. The mean ± SD length of the nerve gap prior to repair was 12 ± 4 mm (5-20 mm) for both groups. The average s2PD for processed allograft was 5 ± 1 mm (n = 6) compared with 8 ± 5 mm (n = 9) for hollow conduits. The average moving 2PD for processed allograft was 5 ± 1 mm compared with 7 ± 5 mm for hollow conduits. All injuries randomized to processed nerve allograft returned some degree of s2PD as compared with 75% of the repairs in the conduit group. Two hollow conduits and one allograft were lost due to infection during the study. Conclusions: In this pilot study, patients whose digital nerve reconstructions were performed with processed nerve allografts had significantly improved and more consistent functional sensory outcomes compared with hollow conduits.

No abstract

No abstract