Abstract:
BACKGROUND: The severity and predictors of functional disability and health-related quality of life
(HRQoL) in a cohort of South Africans with early RA were investigated. METHODS: Changes in
the Health Assessment Questionnaire-disability index (HAQ) and the Short Form-36 (SF-36)
following 12 months of traditional disease modifying anti-rheumatic drugs (DMARDs) were
studied in previously DMARD-naïve adults with disease duration ≤ 2 years. RESULTS: The
majority of the 171 patients were female (82%), black Africans (89%) with a mean (SD)
symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were
significant improvements in the HAQ and all domains of the SF-36, but 92 (69%) still had
substantial functional disability (HAQ >0.5), and 89 (66%) had suboptimal mental health (SF-36
mental composite score <66.6). Multivariate analysis showed that female sex (p=0.05) and high
baseline HAQ (p<0.01) predicted substantial functional disability at 12 months. Unemployment (p=0.03), high baseline pain (p=0.02) and HAQ (p=0.04) predicted suboptimal mental health,
with a trend towards low level of schooling being significant (p=0.08). CONCLUSIONS: Early RA
has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still
showing substantial functional disability and suboptimal mental health despite 12 months of
DMARD therapy. Further research is needed to establish the role of interventions including
psycho-social support, rehabilitation programmes and biologic therapy to improve physical
function and HRQoL in this population.
