Loss of physical independence in rheumatoid arthritis: interview data from a representative sample of patients in...

The goal of the study was to obtain an estimate of the proportion of patients with rheumatoid arthritis (RA) in rheumatologic care who are unable to live independently. It investigates the association of age, disease duration, disease activity, joint involvement, and comorbidity with dependence on help and care. In addition, we 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.

A sample of 273 patients with RA and considerable physical disabilities (less than 67% of full functional capacity) was drawn from the Berlin rheumatologic database. Standardized questionnaires and interview data were used to ascertain dependence on help and care. Patients were classified as in need of help when they depended on external help to manage household chores and as in need of care if beyond this they depended on assistance to manage personal hygiene and nutrition.

More than 50% of the patients who had less than 58% of full functional 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 treated by rheumatologists in Berlin, 33% were expected to be dependent on external help and 7% to be dependent on care. Even in patients with disease duration < or = 5 years, a rather high expected proportion of help-dependence was found (26%). When single joints were compared, the highest amount of disability resulted from impaired wrists. Our data suggest that the contribution of comorbidity to functional impairment was low, especially in patients in need of help, while patients independent of help reported more frequently that their comorbid condition had an impact on their physical function.

The results support the importance of identifying high-risk patients and of the employment of a strategy of early therapeutic intervention, since a high degree of dependence on help was observed in patients with short disease duration. As help-dependence is highly influenced by the condition of the wrists, more attention should be paid to the treatment and stabilization of these joints.