Prevalence of functional disability in patients with rheumatoid arthritis attending the rheumatoid outpatient clinic at Kenyatta National Hospital

Abstract

Background: Rheumatoid Arthritis (RA) causes serious joint erosion,  deformity and severe functional disability if not diagnosed early and followed by a timely initiation of Disease Modifying Anti- Rheumatic Drugs (DMARDs). Studies have shown that functional disability is a major determinant on the patients’ quality of life and it is a strong predictor of morbidity, work disability and mortality. Functional disability is measured by patient-oriented tools such as the Health Questionnaire Disability Index (HAQDI) which is the gold standard tool.

Objective: This study aimed to determine the prevalence of RA functional disability and its association with disease activity, socio-demographic and clinical characteristics in patients with rheumatoid arthritis on follow up at the Rheumatology Outpatient Clinic in Kenyatta National Hospital (KNH).

Design: This was a descriptive crosssectional hospital-based study.

Setting: Rheumatology Outpatient Clinic (ROPC) at the Kenyatta National Hospital (KNH); the largest public national and referral hospital in Kenya.

Subjects: One hundred and six patients who fulfi lled the 2010 American College of Rheumatology and the European League Against Rheumatism (ACREULAR) criteria.

Results: There were 102(96.2%) females and 4(3.8%) males recruited into the study with a female to male ratio of 10:1. The prevalence of functional disability was 72.6% with a mean HAQ-DI of 0.41±0.38 which is interpreted as mild disability. Active disease was present in 90.6% of the patients with a median CDAI of 11(IQ range 6.5-22) and mean CDAI score of 15.95±13.08 which represents moderate disease activity and only 9.4% were in remission. The average duration of disease was 5.1 years.  Functional disability was signifi cantly correlated with disease duration and treatment duration.

Conclusion: The study demonstrated a high prevalence of functional disability and a higher disease activity of among RA patients in our setting despite being on DMARDs. There was a signifi cant correlation between functional disability and disease duration. However, there were no  correlations between functional disability and any of the sociodemographic study variables; age, sex, marital status, employment, education and smoking history.