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Original research
The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial
  1. Kyriaki Keramiotou1,2,
  2. Christos Anagnostou2,
  3. Evangelia Kataxaki2,
  4. Antonios Galanos3,
  5. Petros P Sfikakis1 and
  6. Maria G Tektonidou1
  1. 1First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  2. 2Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
  3. 3Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", National and Kapodistrian University of Athens, Athens, Greece
  1. Correspondence to Professor Maria G Tektonidou; mtektonidou{at}


Objective To assess the effect of upper limb exercise on hand function, daily activities performance and quality of life of patients with systemic lupus erythematosus (SLE).

Methods We 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.

Results From 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.

Conclusion Upper-limb exercise significantly improves hand function, pain, daily activity performance and quality of life in SLE.

Trial registration number NCT03802578.

  • systemic lupus erythematosus
  • exercise
  • upper limb exercise
  • hand function
  • daily performance
  • quality of life

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  • Contributors MGT had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: MGT, KK, CA. Acquisition, analysis or interpretation of data: KK, MGT, PPS, EK, CA, AG. Drafting of the manuscript: KK, MGT, CA, AG. Critical revision of the manuscript and approval of the manuscript: KK, CA, EK, PPS, MGT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PPS has received consulting fees and/or grants from AbbVie, Pfizer, MSD, Roche, UCB, GSK and Novartis deposited to the Special Account for Research Funding (ELKE) of the National and Kapodistrian University of Athens Medical School. MGT has received consulting fees and/or grants from AbbVie, GSK, MSD, UCB, Novartis and Pfizer deposited to the ELKE of the National and Kapodistrian University of Athens Medical School.

  • Patient consent for publication Not required.

  • Ethics approval The research ethics committee of ‘Laiko’ and ‘Thriasio’ hospitals approved this study and all participants provided written informed consent in accordance with the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The protocol and data sets generated for this study are available on request to the corresponding author.

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