Destructive reumatoid arthritis : Epidemiological, economic, and rheumasurgical aspects
Abstract: This study comprising 8 separate papers is concerned with the prevalence of rheumatic disease and different aspects of destructive rheumatoid arthritis in the population. In an epidemiologically representative population subjective joint disease was found in 30% in ages 45 years and over. All those people were clinically examined and diagnosis established. Joint disease becomes commoner with increasing age and causes considerable disability. Destructive rheumatoid arthritis, ARA criteria 5-8, i.e. classical and definite RA, was found in 0.65% of the population. This patient group with joint destructions is the most interesting from rheumasurgical view. A clinical evaluating system, total locomotion score, comprising of a subjective and an objective part, was developed for numerical multifactorial assessment of patients with destructive RA. It is based on WHO's recommandations for disease integration (1980). This system was tested and was found to have good interobserver reliability and showed good correlation between patient's subjective and objective status. All 82 RA patients found in the epidemiological population were evaluated by total locomotion score and for hand function with Sollerman's hand function test and current status emerged. The destructive RA manifestations of the locomotor system, including the hand, were increasing with age, longer disease duration, and were more pronounced in women than men. In this patient group further reconstructive operations were needed in 55% of cases and this care was closely correlated with low total locomotion score. Reconstructive joint and hand surgery was found to prevent deterioration of the disease. The costs of RA were correlated to effects of the disease destructions; patients in working-age had highest indirect costs and elderly patient medical and social costs. Total costs of the disease were better correlated to the status of lower extremities than upper. Elbow replacement in RA reliefs pain well and improves function of arm and hand. Total hip and knee replacement in RA improves status regardless age, sex, and low preoperative total locomotion score. Besides better quality of life, reduced indirect costs and reduced costs of home help are achieved.
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