FUNCTIONAL IMPAIRMENT AND DISABILITY IN EARLY RHEUMATOID-ARTHRITIS - DEVELOPMENT OVER 5 YEARS

Objective. To evaluate the development of functional impairment and di sability in early rheumatoid arthritis (RA). Methods. Sixty-three pati ents with definite RA with mean disease duration of about 1 year were followed for 5 years. Joint inflammation was evaluated with an active joint count, and radiographic changes in hands and feet with the Larse n method. Functional impairment of particular joint systems was assess ed with a performance index, Signals of Functional Impairment Index, a nd disability with the Health Assessment Questionnaire (HAQ). Results. During the observation time the disease activity decreased, and the r adiographic changes of hands and feet increased significantly. Joint r eplacements in 10 hips, 1 knee, and 1 shoulder were performed in 9 pat ients after median 43 months. At study start almost half the patients had impaired hand function, mostly affecting finger flexion and pincer grip. The most marked deterioration of joint function had occurred al ready after 2 years in metatarsophalangeal joints (55%), elbow joints (35%), ankle joints (30%), shoulder joints (28%), and hip joints (25%) . The median HAQ level at study start was 0.8, and the median change o f HAQ over 5 years was 0.1 (not significant). The progression of dysfu nction was not linear but followed a highly variable course over the y ears. Patients with higher HAQ scores at study end could be correctly classified in 75% of the cases by the 3 factors, baseline HAQ score, f emale sex, and a low educational level. Presence of a replaced joint d id not contribute significantly, but patients with joint replacement t ended to be more disabled. Conclusion. Functional outcome of RA after about 6 years of disease was fairly good. Functional impairment of dif ferent joints had progressed, but most patients were still mildly disa bled. A subgroup of 9 patients had a worse disease course with rapidly progressing large joint destruction.