OBJECTIVE: To examine the severity of rheumatoid arthritis (RA), as defined by the American Rheumatism Association (ARA) 1987 revised criteria, at the population level. METHODS: The level of functional disability of the 103 patients with RA who represented practically all subjects with RA in a rural community of 13,000 adult inhabitants was assessed by the ARA Functional Classification and the Health Assessment Questionnaire (HAQ). RESULTS: Only one of the 103 patients was bedridden (ARA Class IV). According to the HAQ Functional Disability Index (FDI) two thirds of the patients had mild or at most moderate disability. Overall, less than 10% of the patients in the community were severely disabled. CONCLUSION: The level of disability in our series is lower than that reported earlier in populations with RA. These patients were treated aggressively with a median interval of one year from the first joint symptoms to the start of disease modifying antirheumatic drugs and had a median number of 2 orthopedic operations. How these interventions influenced the result cannot be accurately assessed on the basis of our cross sectional study protocol. However, high grade impairment due to destruction of large joints of lower limbs was in most instances compensated by total joint replacement surgery, performed in 20% of the cases in the series. This may partly explain the low prevalence of totally disabled patients with severe restriction in mobility in this population.
OBJECTIVE: To examine the severity of rheumatoid arthritis (RA), as defined by the American Rheumatism Association (ARA) 1987 revised criteria, at the population level. METHODS: The level of functional disability of the 103 patients with RA who represented practically all subjects with RA in a rural community of 13,000 adult inhabitants was assessed by the ARA Functional Classification and the Health Assessment Questionnaire (HAQ). RESULTS: Only one of the 103 patients was bedridden (ARA Class IV). According to the HAQ Functional Disability Index (FDI) two thirds of the patients had mild or at most moderate disability. Overall, less than 10% of the patients in the community were severely disabled. CONCLUSION: The level of disability in our series is lower than that reported earlier in populations with RA. These patients were treated aggressively with a median interval of one year from the first joint symptoms to the start of disease modifying antirheumatic drugs and had a median number of 2 orthopedic operations. How these interventions influenced the result cannot be accurately assessed on the basis of our cross sectional study protocol. However, high grade impairment due to destruction of large joints of lower limbs was in most instances compensated by total joint replacement surgery, performed in 20% of the cases in the series. This may partly explain the low prevalence of totally disabled patients with severe restriction in mobility in this population.