FUNCTIONAL DISABILITY INDICES IN EARLY RHEUMATOID ARTHRITIS AND ITS CORRELATION WITH CLINICAL, LABORATORY AND RADIOLOGICAL FINDINGS

Abstract

Rheumatoid arthritis is a chronic systemic inflammatory illness which is associated with increased mortality and morbidity. Patients with more severe disease activity have the highest mortality rate. The clinical course of RA is highly variable.

A small percentage of patients go into remmision, generally within the first two years of the disease onset. Most patients have variable disease activity with 15%-25% having a progressive course despite maximal medical therapy. Factors that indicate poor prognosis include RF positivity, extra­ articular involvement, multiple joint affection on presentation, functional disability within one year of onset, Jack of formal education, low socioeconomic status and persistently abnormal acute phase reactants.

The aim of this study is to analyze the correlation of functional disability scores with other measures of clinical status, laboratory findings and radiographic scores in patients with recent onset RA.

This study was carried out on forty patients with recent onset RA, who attended the outpatient clinic of Physical Medicine and Rehabilitation Department of Tanta University Hospitals. They had RA according to the ACR criteria. Our patients had a disease duration of < 2 years and had not been previously treated with DMARDs.

They were subjected to the following assessment:

1- Complete history taking.

2- General examination and locomotor examination.

3- As regards pain the joints were assessed according to ; pain and geneal health assessment on visual analogue scale.

4- As regards tenderness and swelling: The joints were assessed according to 28-joint count measuring tender joints (28T), swollen joints , and joints that are both tender and swollen (28 T & S).

5- Laboratory assessment:

A) Complete blood picture.

B) Erythrocyte sedimentation rate. C) C-Reactive protein. D) Rheumatoid factor by (Latex fixation test). E) Rheumatoid factor immunoglobulin-M by ELISA.

6- Radiological assessment:

A) Plain X-ray for hand and foot.

B) Radiological assessment by a new method of scoring developed by

Rau eta!(1998).

7- Assessment of disease activity:

By Modified disease activity score.

8- Functional assessment:

By Arthritis Impact Measurement Scale 2 questionnaire