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Introduction Hand impairment is a significant burden in systemic sclerosis (SSc), affecting quality of life mainly due to local skin fibrosis and joint contractures. Traditional clinimetric scores often lack the sensitivity required for precise assessment, highlighting the need for more objective tools. The Hand Test System (HTS), an engineered glove, quantifies dexterity through parameters such as touch duration (TD), inter-tapping interval (ITI), and movement rate (MR) [ figure 1], and has been previously used in rheumatoid arthritis.The primary objective was to assess the utility of the HTS glove for measuring hand dexterity in SSc patients by comparing their performance to matched healthy controls (HC). Secondary aims involved exploring correlations between HTS parameters and patient-reported outcomes (PROMs), nailfold videocapillaroscopy (NVC), and dermal thickness (dt) as measured by high-frequency skin ultrasonography (HFSU).Material and Methods This study included 25 SSc patients, classified with ACR/EULAR 2013 criteria, and 25 HCs. All subjects were evaluated using the HTS glove and three PROMs: the SHAQ, Hand Mobility in Scleroderma (HAMIS) test, and Duruöz Hand Index (DHI). The SSc cohort underwent standard clinical assessment, NVC, dt, evaluated with 22 MHz HFSU, and modified Rodnan skin score (mRSS).Results Highly significant differences were observed between SSc patients and HCs, with patients showing prolonged TD and ITI and reduced MR, indicating slower, less efficient hand movements (all p < 0.001). Within the SSc group, HTS parameters significantly worsened with poorer PROMs (ITI vs. SHAQ and DHI, r > 0.6, p < 0.005). Notably, mean TD demonstrated a significant direct correlation with HFSU-measured dt of the hand dorsum (left hand: r = 0.65, p = 0.001; right hand: r = 0.66, p = 0.001) and total dt (r = 0.45, p = 0.04). In addition, both mean TD and ITI directly correlated with the mRSS (ITI: r = 0.4, p = 0.03; MR: r = 0.42, p = 0.03). Subgroup analyses revealed no significant associations between HTS parameters and organ involvement and autoantibody profiles. Altered HTS values were observed in patients showing a higher frequency of ‘late’ (48%) and ‘active’ (36%) compared to ‘early’ (16%) NVC patterns.Conclusions The HTS glove provides detailed, quantitative data on hand function in SSc. The strong correlations with PROMs and with HFSU-measured dermal thickness, underscore a significant link between skin fibrosis and functional hand impairment. Future research is in progress to validate the HTS’s role in tracking disease progression and treatment response in SSc.Abstract P.234 Figure 1The HTS glove exercise. The exercise consisted of having the patient repeat a sequence of touch as many times as possible in 20 seconds, involving the thumb and one finger at a time (thumb and index finger, thumb and middle finger, thumb and ring finger and thumb and little finger)