Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years

Authors

  • Theodore Pincus MD,

    Corresponding author
    1. Division of Rheumatology and Immunology
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
    • Division of Rheumatology and Immunology, Department of Medicine, B-3219 Medical Center North, Vanderbilt University, Nashville, TN 37232
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  • Leigh F. Callahan BS,

    1. Division of Rheumatology and Immunology
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
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  • William G. Sale MD,

    1. Department of Orthopedic Surgery and Rehabilitation
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
    Current affiliation:
    1. 33 Brook Street, Charleston, WV 25301
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  • Arthur L. Brooks MD,

    1. Department of Orthopedic Surgery and Rehabilitation
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
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  • Lee E. Payne MD,

    1. Division of Rheumatology and Immunology
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
    Current affiliation:
    1. Department of Medicine, University of Colorado Health Sciences Center, Denver, Co 80262
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  • William K. Vaughn PhD

    1. Division of Biostatistics, Department of Preventive Medicine.
    2. Division of Rheumatology and Immunology, Department of Medicine, the Department of Orthopedic Surgery and Rehabilitation, and the Division of Biostatistics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
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Abstract

Seventy-five patients with rheumatoid arthritis (RA) were reviewed 9 years after an extensive evaluation which included quantitative measures of functional capacity. These patients had received multiple intraarticular injections of thiotepa with corticosteroids early in their course, but appear demographically and functionally similar to other RA patients who had not received this therapy. Severe morbidity was seen over the 9-year period in the 55 surviving patients, including significantly lower overall functional capacity in 92% of patients studied, lower grip strength in 93%, and longer button test results in 84%. Work disability occurred in 85% of patients under age 65 who had been working full-time at disease onset. There was increased mortality at the 9-year review, similar to most reported series of RA patients from referral centers; however, a significant increase in neoplasia, which was of concern because of the use of intraarticular thiotepa, was not seen. In terms of functional capacity, including responses to questions about ability to perform activities, walking time, and the button test, those patients who had died prior to review had significantly lower baseline values than did those who survived. Of the 75 patients, 20 had died and 51 had lost significant functional capacity over a 9-year period, documented by quantitative measures of functional capacity.

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