Rheumatology 2000; 39: 603-611
© 2000 British Society for Rheumatology
How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS)
City Hospital, St Albans AL3 5PN,
1 Orthopaedic Hospital, Oswestry TF6 6TF,
2 Royal Hants Hospital, Winchester SO22 5DG,
3 Broomfield Hospital, Chelmsford CM1 6ET,
4 Selly Oak Hospital, Birmingham B29 6JD,
5 Rheumatology Research Unit, Leeds LS2 9NZ,
6 CORU, UCL, London WC1E 6BT,
7 Diana Princess of Wales Hospital, Grimsby DN33 2BA,
8 North Hampshire Hospital, Basingstoke RG24 9NA,
9 Medway Hospital, Gillingham ME7 5NY and
10 Nether Edge Hospital, Sheffield S11 9EL, UK
Objectives. To assess the impact of rheumatoid arthritis (RA) on function and how this affects major aspects of patients' lives.
Methods. The inception cohort of RA patients was recruited from rheumatology out-patient departments in nine National Health Service (NHS) hospital trusts in England. All consecutive patients with RA of less than 2 yr duration, prior to any second-line (disease-modifying) drug treatment were recruited and followed-up for 5 yr. Standard clinical, laboratory and radiological assessments, and all hospital-based interventions were recorded prospectively at presentation and yearly. The outcome measures were clinical remission and extra-articular features, functional ability [functional grades I–IV and Health Assessment Questionnaire (HAQ)], use of aids, appliances and home adaptations, orthopaedic interventions, and loss of paid work.
Results. A total of 732 patients completed 5 yr of follow-up, of whom 84% received second-line drugs. Sixty-nine (9.4%) had marked functional loss at presentation, compared with normal function in 243 (33%), and by 5 yr these numbers had increased in each group, respectively, to 113 (16%) and 296 (40%). Home adaptations and/or wheelchair use by 5 yr were seen in 74 (10%). Work disability was seen in 27% of those in paid employment at onset. One hundred and seventeen (17%) patients underwent orthopaedic surgery for RA, 55 (8%) for major joint replacements. Marked functional loss at 5 yr was more likely in women [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.04–2.5], patients older than 60 yr (OR 1.94, 95% CI 1.3–2.9), and with HAQ > 1.0 at presentation (OR 4.4, 95% CI 2.8–7.0).
Conclusions. Clinical profiles of RA patients treated with conventional drug therapy over 5 yr showed that a small proportion of patients (around 16%) do badly functionally and in terms of life events, whereas around 40% do relatively well. The details and exact figures of cumulative disability are likely to be useful to clinicians, health professionals and patients. The rate of progression and outcome in these patients can be compared against future therapies with any disease-modifying claims.
KEY WORDS: Rheumatoid arthritis, Function, Outcome, Work disability, Orthopaedic surgery
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