Disability and handicap in rheumatoid arthritis and ankylosing spondylitis- Results from the German rheumatological database

Objective. To describe indicators of disability and handicap in the 2 major inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing s pondylitis (AS) and to estimate the burden of illness in terms of functiona l status, pain, and global well being, as well as with regard to unemployme nt and early retirement. Methods. Data from the German rheumatological database on 52,444 patients w ith RA and 8,776 patients with AS seen at 21 collaborative arthritis center s in Germany between 1993 and 1997 were analyzed. To estimate the burden of the 2 diseases at different biographical phases, age and sex matched group s of patients were compared for functional disability, pain, global assessm ent of health status, education level, and employment status. Results, For comparable ages, disability in female patients with AS or RA w as rated similarly by the physicians (e.g., 61-70 years: 42% severe disabil ity in RA and 44% in AS), whereas men with AS were rated more disabled than men with RA (61-70 years: 35% in RA and 48% in AS). Patients' self-ratings of disability were generally worse for women than for men (age 61-70: wome n 37% severe disability in RA and 35% in AS, men: 24% in RA and 19% in AS). Pain intensity was rated similarly by women and men with RA and AS at ages < 51 years (33% severe pain at ages 41-50 in men and 34% in women in both diseases). It increased with age in women (> 70 years: 41% severe pain in R A and 44% in AS) and remained stable in men (27% RA and 29% AS > 70 years). At 71.3% the employment rate in AS was clearly higher than in IA (49.5%). There was significant influence of the education level (men 51-60 years wit h AS: low education 56% employment rate, high education 79%) and the labor market (men 51-55 years with AS: 80% employment rate under good, 59% under bad overall labor market conditions). Conclusion. Age and sex matched groups of patients with RA and AS in tertia ry rheumatological care show similar amounts of disability, pain, and reduc tion in well being. Therefore, the offer of comprehensive care and pain man agement to both groups should be comparable.