Loss of physical independence in rheumatoid arthritis: Interview data froma representative sample of patients in rheumatologic care

Objective. The goal of the study was to obtain an estimate of the proportio n of patients with rheumatoid arthritis (RA) in rheumatologic care who are unable to live independently, It investigates the association of age, disea se duration, disease activity, joint involvement, and comorbidity with depe ndence on help and care. In addition, rye attempt to derive an estimate of the level of physical disability at which dependence on external help is to be expected in more than 50% of the cases. Methods. A sample of 273 patients with RA and considerable physical disabil ities (less than 67% of full functional capacity) was drawn from the Berlin rheumatologic database. Standardized questionnaires and interview data wer e used to ascertain dependence on help and care. Patients were classified a s in need of help when they depended on external help to manage household c hores and as in need of care if beyond this they depended on assistance to manage personal hygiene and nutrition. Results. More than 50% of the patients who had less than 58% of full functi onal capacity (Health Assessment Questionnaire [HAQ] >1.54) required help, and for patients with less than 30% (HAQ >2.3) the need for help was almost certain (more than 95%). Generalizing these results to all RA patients tre ated by rheumatologists in Berlin, 33% were expected to be dependent on ext ernal help and 7% to be dependent on care. Even in patients with disease du ration less than or equal to5 years, a rather high expected proportion of h elp-dependence was found (26%). When single joints were compared, the highe st amount of disability resulted from impaired wrists. Our data suggest tha t the contribution of comorbidity to functional impairment was low, especia lly in patients in need of help, while patients independent of help reporte d more frequently that their comorbid condition had an impact on their phys ical function. Conclusion. The results support the importance of identifying high-risk pat ients and of the employment of a strategy of early therapeutic intervention , since a high degree of dependence on help was observed in patients with s hort disease duration. As help-dependence is highly influenced by the condi tion of the wrists, more attention should be paid to the treatment and stab ilization of these joints.