Background Rheumatoid arthritis (RA) is a chronic inflammatory disease with exacerbation and remission periods. Patients tend to limit their physical activity levels further during the exacerbations in addition to already existing physical inactivity due to the chronic disease course. Such a decrease in physical activity results in impairments in activities of daily life requiring musculoskeletal structures especially the hand.
Objectives The aim of this study is to evaluate the relationship between the disease activity and hand functional level.
Methods Patients (30-60 years) with RA from both inpatient and outpatient departments participated in the study. Disease activity was determined with Disease Activity Score-28 (DAS-28) and functional level of hand was assessed by grip and pinch (lateral, bipod, tripod) strength measurements and Nine-Hole Peg Test. All participants completed Michigan Hand Outcome Questionnaire in order to determine the disability level of hand.
Results Fifty patients (29 inpatients and 21 age-matched outpatients) participated in the study. Comparison of the two groups showed that DAS-28 scores were significantly different (p<0,05). DAS-28 scores were significantly inversely correlated to all three pinch strenghts, Nine-Hole Peg Test and Michigan scores (p<0,05). Intra-group correlations showed no relationship between DAS-28 scores and hand functions in the outpatient group (p>0,05); however, inpatient group showed a significant correlation between the disease activity and hand functional tests (p<0,05).
Conclusions Our results showed that disease activity is in an inverse relationship with the functional level of hand in patients with RA. Additionally, that relationship still exists in the inpatient group, indicating the increase in disease activity results in more impairment of hand despite the outpatient group showed no relationship between the outcomes. Therefore, hand therapy should be established as a crucial part of the treatment of RA even in the flaring period of the disease.
Arreguín Reyes R, Lόpez Lόpez CO, Alvarez Hernández E, Medrano Ramírez G, Montes Castillo Mde L, Vázquez-Mellado Evaluation of hand function in rheumatic disease. Validation and usefulness of the Spanish version AUSCAN, m-SACRAH and Cochin questionnaires.J.Reumatol Clin. 2012 Sep-Oct;8(5):250-4. Epub 2012 May 17.
O'Connor D, Kortman B, Smith A, Ahern M, Smith M, Krishnan J.J Correlation between objective and subjective measures of hand function in patients with rheumatoid arthritis.Hand Ther. 1999 Oct-Dec;12(4):323-9.
Öksüz Ç, Akel BS, Oskay D, Leblebicioglu G, Hayran KM. Cross-Cultural Adaptation, Validation, and Reliability Process of the Michigan Hand Outcomes Questionnaire in a Turkish Population J Hand Surg 2011;36A:486–492.
Disclosure of Interest None declared