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Aspects of disability in early rheumatoid arthritis: a five-year follow-up in the Swedish TIRA project
Linköpings universitet, Hälsouniversitetet.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents.

 

This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients.

For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

Place, publisher, year, edition, pages
2008.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1063
Keywords [en]
Rheumatoid arthritis (RA), disability, hand function, pain intensity, ADL, sick leave, prediction
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:hj:diva-7161ISBN: 978-91-7393-908-9 (print)OAI: oai:DiVA.org:hj-7161DiVA, id: diva2:128022
Public defence
(English)
Supervisors
Available from: 2009-06-18 Created: 2008-12-11 Last updated: 2009-06-18Bibliographically approved
List of papers
1. Hand function in women and men with early rheumatoid arthritis: A prospective study over three years (the Swedish TIRA project)
Open this publication in new window or tab >>Hand function in women and men with early rheumatoid arthritis: A prospective study over three years (the Swedish TIRA project)
2006 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 35, no 1, p. 15-19Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-6854 (URN)
Available from: 2008-11-27 Created: 2008-11-27 Last updated: 2017-12-14Bibliographically approved
2. Hand Function and Activity Limitation According to Health Assessment Questionnaire in Patients with Rheumatoid Arthritis and Healthy Referents: 5-Year Followup of Predictors of Activity Limitation (The Swedish TIRA Project)
Open this publication in new window or tab >>Hand Function and Activity Limitation According to Health Assessment Questionnaire in Patients with Rheumatoid Arthritis and Healthy Referents: 5-Year Followup of Predictors of Activity Limitation (The Swedish TIRA Project)
2007 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 34, no 2, p. 296-302Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-7157 (URN)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
3. Multivariate relationships between pain intensity and other aspects health in rheumatoid arthritis: Cross sectional and five year longitudinal analyses (the Swedish TIRA project).
Open this publication in new window or tab >>Multivariate relationships between pain intensity and other aspects health in rheumatoid arthritis: Cross sectional and five year longitudinal analyses (the Swedish TIRA project).
2008 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 19, p. 1429-1438Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-7158 (URN)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
4. Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project
Open this publication in new window or tab >>Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project
Show others...
2009 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 36, no 6, p. 1170-1179Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Our study describes sick leave during 3 years before and 3 years after diagnosis of rheumatoid arthritis (RA) in relation to referents and identifies predictors for sick leave during the third year after diagnosis of RA. METHODS: One hundred twenty patients (76% women) from the Swedish early RA study TIRA were included. Disease activity and disability were registered regularly during 3 years in TIRA. Referents were matched for sex, age, and home town. Sick leave data were obtained for patients 3 years before and 3 years after diagnosis and for the referents for the corresponding 6 years. RESULTS: No differences were seen between patients and referents regarding sick leave during the first 2 years, whereas sick leave increased in patients 6 months before diagnosis, from 30% to 53%. During the 3 years after diagnosis, sick leave among patients was rather stable, varying between 50% and 60%, even though disability pension increased and sickness benefit decreased. Sick leave before diagnosis, disability 1 year after diagnosis, and type of work were identified as predictors for sick leave during the third year after diagnosis. CONCLUSION: Not surprisingly, sick leave in patients increased the year before diagnosis. Although disease activity and disability diminished after diagnosis, the patients' sick leave remained essentially unchanged. Sick leave 3 years after diagnosis was foremost predicted by earlier sick leave, disability, and type of work.

Identifiers
urn:nbn:se:hj:diva-7160 (URN)10.3899/jrheum.080523 (DOI)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved

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