[Effects of therapy on functional ability of patients with rheumatoid arthritis].

Unlabelled: Rheumatoid arthritis (RA) is a diseases which causes great suffering of patients, and it demands a complex medicamentosus therapy (including diseases modifying antirheumatic drugs DMARD) and physical therapy. Disease often progresses, in spite of therapy and leads to severe functional disability. That is why it is often discussed whether the usage of expensive therapy such as DMARD is justified. This question is often asked in countries with poor socio economic standard where health funds cannot cover all expenses of the treatment for RA, and patients themselves cannot afford expensive therapy. In order to assess the real potential of DMARD therapy it is necessary to compare results of treatment of patients which do not take those medications. This cannot be done in a country where DMARDs are available to all patients because it would be unethical to take them off drugs. In Bosnia and Herzegovina, a country with a recent war history, there are many RA patients who could not afford those expensive medications and could be examined as a control group in this research. Effects of treatment could be evaluated by analysis of functional ability of patients, because its loss is the first thing that is noticed by patients, right after pain. It is a key factor in the strategy development of examination, treatment and analysis of patients with RA. The aim of this research was to evaluate the efficacy of the DMARD and physical therapy on the functional ability of patient with rheumatoid arthritis (RA).

Methods: The research was conducted on 40 RA patients who were under the control of the rheumatologist, were taking DMARD and were hospitalized at the rehabilitation clinic for physical therapy once in a year, and later conducted exercises at home. Control group had 70 RA patients, who were not under the control of rheumatologists and did not take drugs from the DMARD group, nor did they use physical therapy. Groups were comparable according to age, duration of their disease, sex and presence of RF. Functional ability was assessed with Health Assessment Questionnaire (HAQ). Walking quality and need for prostheses were also evaluated.

Results: According to HAQ mild functional disability was found in 69% of the examined group and in 9% of the control group, moderate functional disability was found in 30% of the examined group and in 29% of the control group. Severe functional disability and dependency of other people's help was found in 2% of the examined group and in 26% of the control group. Complete disability was not found in the examined group and was found in 14% of the control group. 65% of patients in the examined group did have problems with walking while 25% did not. Remaining 10% had to use one stick while walking. In control group 3% did not have any problems with walking, 42% did, 31% used stick, 13 % used crunches, and wheel chairs were necessary for 7% of patients.

Discussion: This research showed that functional disability progresses in patients who are treated and the ones that are not. There is a significant difference in the severity of functional disability among examined groups (p < 0.00001). Among patients that are using DMARD and physical therapy there are no patients that are completely dependent, using crutches or wheel chair. That is justified reason for finding the means for quality treatment of patients with RA.

Conclusion: Out of this research one can conclude that drugs can slow the progression of the disease, but with the usage of the contemporary therapy with DMARD and regular physical therapy one could modify the course of the disease and significantly reduce the functional disability of RA patients.