Background/Purpose

Even now, in clinical practice, most of RA patients have long-standing disease and structural damage in their joints. Reconstructive joint surgery should be needed for further improvements of physical function for long-standing RA patients. It is very important to understand how much range of motion (ROM) should be needed to gain better physical function in each case.

The purpose of this study is to explore the characteristics of functional impairment and relationship ROM of joints and physical function in RA patients who were needed joint surgery using multicenter prospective cohort.

Methods:

We started the prospective study in September, 2012 (Study registration: UMIN000012649). We collected data on age, sex, disease duration, drug therapies, and disease activity. Functional evaluations were made using the HAQ-DI, DASH (Disability of Arm, Shoulder and Hand; upper limb function), and JSSF-RA (foot and ankle function), and patient subjective evaluations using the EQ-5D (QOL) and BDI-II (depression). Joint range of motion was also measured as part of this evaluation. This study is supported by grant from the Japanese Ministry of Health, Labour and Welfare.

Results:

347 surgical patients were registered. Mean values for age, disease duration, and sex were 65.2 years, 18 years, and 88% female, respectively.  Actually, even long-standing RA patients who were needed joint surgery had remission or low disease activity in this baseline data (median values for DAS28 (3.0) and CRP (0.33 mg/dl). 23.8% of the patients were treated with biologics.   We confirmed the significant correlation between HAQ-DI and EQ-5D, BDI-II; DASH and BDI-II (P<0.05). Assistive use of upper limb was required for arising, climbing stairs, standing up from the sofa, and walking outside by 52%, 51%, 44%, and 29% of patients, respectively.

We found significant relationship between ROM of joints in upper limb (shoulder, elbow and wrist) and the level of disability in HAQ-DI: Question 2 (shampoo hair), Q4 (arising), Q11 (tub bathing), and Q16 (opening and closing a wide mouth jar).

ROMs of the joints [age-adjusted mean values (95% CI)] which represented nearly non-existent levels of disability in each questioner of HAQ-DI, are as follows; wrist; flexion-extension 69.9 (61.4-78.5)°, pronation and supination 151.0 (145.4-158.6)°, elbow; flexion 135.3 (131.9-138.7)°, and shoulder; flexion 129.6 (122.2-137.0)°. (Fig. A and B).

Conclusion

ROMs of the joints in upper limbs were significantly associated with many kinds of daily activity including arising and bathing. The information should be important for assessment of disability in patients with long-standing RA. The ROM as shown in this study could be target of surgical procedure. It will be validated by further analysis of longitudinal data of this study