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AB0040 The influence of the war conditions on the treatment course of rheumathoid arthritis
  1. N Kapidzic-Basic,
  2. H Seleskovic,
  3. S Kikanovic,
  4. S Mulic
  1. Rheumathology, Clinic for Physical Medicine and Rehabilitation, Tuzla, Bosnia and Herzegovina


Background Complicated therapy of the rheumatoid arthritis does not always give satisfying results so there is an opinion that the disease progresses with or without the treatment. During the war in Bosnia and Herzegovina (BiH) neither diagnostic nor therapy were possible and difficulties went on after the war. Humanitarian aid brought only certain amount of medications from the NSAIDs group, and DMRADs were used rarely.

Objectives The aim of this work was to determine the severity of the change on locomotion system of RA patients who did not take DMARDs therapy during the war and to determine functional disability of those patients.

Methods Examination was conducted on 100 RA patients (according to modified ACR criteria) who had no therapy, but occasional NSAIDs during the 6 year period, nor physical therapy. Control group was 40 RA patients who lived outside of BiH during the war and who had taken DMARDs and physical therapy. Both groups were comparable with the length of the disease. The activity of the disease was evaluated (ESR, CRP, morning stiffness, visual analogue scale of pain, Ritchie index of joints sensitivity) as well as functional state index measured by HAQ, range of motion (ROM) and radiological examination.

Only one part of this large study will be presented here.

Results Mean duration of the disease was 12,1 years (SD 8,3). According to HAQ three groups were made: mild disability 0–1 (11% of patients), moderate 1,01–2.0 (40% of patients) and severe 2,01–3 (49%). 4% of patients had no movement. HAQ results of the control group were following: 67,5% of patients were in the I group, 30% patients were in the II group and 2,5% of patients were in the III group. In the study of Wolfe et al.1 43,25% patients were in the I group, 42,5% of patients were in the II group and 14,5% of patients were in the III group. And all other parameters were worse than the ones in the control group.

Conclusion It is obvious that disease strongly progresses without the usage of the drugs and physical therapy. More than half of the patients in the examined group were dependable on other people’s help. Problems with the therapy of RA patients do not end with the end of the war because inhabitance became poor and the RA therapy is very expensive for the most patients.


  1. Wolfe F, Kleinheksel SM, Cathey MA, Hawley D, Spitz P, Fries J. The clinical value of the stanford health assessment questionnaire functional disability index in patients with rheumatoid arthritis. J Rheumatol. 1988;15:10

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