Englert H et al. - Autologous stem cell transplantation (ASCT) improved hand scleroderma over 12 months and resolved previously refractory tenosynovitis. Loss of finger abduction was a more sensitive measure of finger clawing than apparent loss of hand length. Methods
Study to assess the structural and functional effects of autologous ASCT on scleroderma finger clawing
Photocopies of hands of 5 scleroderma pts who underwent ASCT were used
Functional assessments used a standardized questionnaire
Results
Pre-ASCT, synovitis and tenosynovitis were present in 5 and 4 pts, respectively
Modified Rodnan hand skin scores ranged from 6–12/12
Following pulsed chemotherapy, synovitis resolved; tenosynovitis often did not
Post-ASCT, skin scores fell in 4 pts (range 0–6/12)
Hand tenosynovitis resolved
With disease remission hand function globally improved
Functional improvement, noted early (+3 mos) and continuously (+12 mos) in disease remitters, occurred in all areas of function
The 2-5 metacarpophalangeal width was reproducible and independent of ASCT therapy
In contrast, hand length and measures of abducted finger span (1-5 fingertip and 2-5 fingertip distance) improved
Finger abduction (abducted 1-5 fingertips/2-5 metacarpophalangeal width) was a more sensitive discriminator of finger clawing than hand length or hand length/2-5 metacarpophalangeal width
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