Upper limb functional disability in early rheumatoid arthritis

Background: in the early 1990’s, Eberhardt et al acknowledged that hand function is affected early on in RA. With the changes in drug treatments more recent studies have however, provided limited insight into upper limb functional ability as predominantly generalised health outcome measures such as the Arthritis Impact Measurement Scale and the Health Assessment Questionnaire have been employed. Although both of these questionnaires have small sub-sections for upper limb function these are not seen as separate sub-analyses in published research. This study aimed to contribute towards the current understanding of how upper limb function is affected in early RA.Methods: 120 patients from eight hospital clinics with a diagnosis (or suspected diagnosis) of rheumatoid arthritis with disease duration of less than 5years were recruited as part of a larger trial on static resting splints. All participants had some hand involvement and were considered suitable for hand splinting at time of referral to out patient occupational therapy departments. The self-report Disability of the Arm, Shoulder and Hand (DASH) questionnaire (Hudak et al 1996) was used to score and analyse upper limb disability.Results: 110 patients (92%) returned completed questionnaires with sufficient information to permit scoring. The group characteristics are presented in the table below. The responses of the DASH questionnaire were scored and analysed. The use of force was a consistent factor in severely limiting individuals abilities; 61% were unable or had severe difficulty in opening jars, 53% had severe difficulties or were unable to take part in recreational activities that required some force or impact through the arm and 41% were unable or had severe difficulties in carrying a heavy object over 10lbs. Participants most frequentlyreported mild or moderate difficulty for dexterity tasks; 70% reporting mild/moderate difficulty in writing, 66% struggling to turn a key and 58% having mild to moderate difficulty in preparing a meal. The daily tasks that caused the least or no difficulties were; managing transport needs 45%, sexual activities 38% and washing hair 37%.Conclusions: upper limb ability is affected early on in RA, tasks that require strength and static grip force appear to cause the most problems for this sample and combined dexterity tasks that require precision but not necessarily force seem to cause the least amount of difficulty