Fex E, Larsson B M, Nived K, Eberhardt K
Department of Rheumatology, Lund University Hospital, Sweden.
J Rheumatol. 1998 Jan;25(1):44-50.
To evaluate the development of handicap in patients with rheumatoid arthritis (RA) followed 8 years from onset.
The study group consisted of 106 patients participating in a prospective early RA study. The mean duration of joint symptoms at inclusion was one year. The patients were assessed at least once annually. Disability was measured with the Health Assessment Questionnaire (HAQ) and emotional distress with a self-administered test (Symptom Checklist). Work status and different social measures were registered. A structured interview regarding work capacity, leisure time, and social activities was performed about 8 years after disease onset.
Compared to study start, disease activity had decreased, emotional distress was unchanged, disability had increased somewhat, and radiographic changes had increased markedly. The prevalence of work disability at the end of the study was 37%. The majority of patients that eventually got disability pension had stopped working the first year after onset. Seventy-eight percent of the patients who continued to work had to adjust their work conditions to stay employed. The 3 most important predictors for work disability were higher HAQ at study start, lower educational level, and older age. Three-quarters of the patients had to alter leisure time activities and half of them were not satisfied with their recreation. Many patients experienced difficulties in their roles as spouse and parent. Higher levels of emotional distress were associated with these handicaps.
In this cohort of patients with RA we found a high frequency of different types of handicaps at an early stage. Slightly more than 1/3 were work disabled. The majority had stopped working during the first year. Patients perceived handicaps in terms of changed leisure time activities, and difficulties performing different social roles were frequent. Patients with these handicaps felt more emotional distress.
评估类风湿关节炎（RA）患者自发病起8年的功能障碍发展情况。
研究组由106名参与前瞻性早期RA研究的患者组成。纳入时关节症状的平均持续时间为1年。患者每年至少接受一次评估。使用健康评估问卷（HAQ）测量残疾情况，通过自我管理测试（症状清单）测量情绪困扰。记录工作状态和不同的社会指标。在疾病发作约8年后，进行了一次关于工作能力、休闲时间和社会活动的结构化访谈。
与研究开始时相比，疾病活动度有所下降，情绪困扰未变，残疾程度略有增加，影像学改变明显增加。研究结束时工作残疾的患病率为37%。大多数最终领取残疾抚恤金的患者在发病后的第一年就停止了工作。继续工作的患者中有78%不得不调整工作条件以维持就业。工作残疾的3个最重要预测因素是研究开始时较高的HAQ、较低的教育水平和较高的年龄。四分之三的患者不得不改变休闲时间活动，其中一半对自己的娱乐活动不满意。许多患者在配偶和父母角色中遇到困难。较高水平的情绪困扰与这些功能障碍相关。
在这个RA患者队列中，我们发现早期不同类型功能障碍的发生率很高。略多于三分之一的患者存在工作残疾。大多数患者在第一年就停止了工作。患者认为休闲时间活动发生了变化，并且经常难以履行不同的社会角色。有这些功能障碍的患者感到更多的情绪困扰。
