[Deficiencies in rehabilitation measures in the course of early chronic polyarthritis]

It was the objective of this descriptive cohort study with prospective and retrospective data collection to examine whether measures of rehabilitation medicine and of vocational rehabilitation are too rare during the course of early rheumatoid arthritis (RA). Seventy three gainfully employed consecutive outpatients with early RA at the first examination (time one -T1) (> or = 5 ARA 1958 criteria, disease duration < or = 12 months) were reexamined at time two (T2) after a mean follow-up of 6 years (S.D. +/- 2 yrs.). Of the 73 patients 27 persons received a social security pension at T2 because of work disability (WD) due to RA. This group was analysed separately from the 34 patients who were still working at T2. Even though the 27 patients with WD had severe disease (functional capacity, ESR, radiological erosions) at T2, only 17 (63%) had participated in inpatient rehabilitation programmes. Despite frequent strenuous job-related physical requirements in 44-70% of the patients with WD measures of vocational rehabilitation had been taken in only 26%: vocational retraining in 4%, adaptation of the workplace because of RA in 8%, reduced working-time in 22%. No patient had changed the job. At least one of these measures of vocational rehabilitation had been taken in only 7 of 34 of the persons working at T2 (21%). Of these 34 patients 21-39% reported continued difficulties with different physical requirements of their jobs. In the early phase of RA significant shortcomings regarding the measures of rehabilitation medicine and vocational rehabilitation could be demonstrated. The early initiation of rehabilitation programmes aims at an improvement of the patient's physical abilities and an adjustment of the job requirements.