Shoulder joint involvement in patients with newly diagnosed rheumatoid arthritis. Prevalence and associations.

OBJECTIVE: To estimate the prevalence of reduced function, compared to normative values, and tenderness in the shoulder in patients with newly diagnosed rheumatoid arthritis (RA), and to investigate associated factors. METHODS: Eighty consecutive patients with RA, participating in a prospective study of early rheumatoid arthritis, were examined and assessed within one year of the onset of symptoms. RESULTS: The prevalence of tenderness from any of the shoulder joints was 50%, while 30% had decreased shoulder function, compared with age matched controls, in at least one shoulder. Both tender shoulder joints and decreased shoulder function were related to higher age and more severe disease, reflected by disability (HAQ) and the patient's assessment of pain and global disease activity. CONCLUSION: The shoulder girdle is involved early and often in rheumatoid arthritis and involvement is associated with a substantially more severe disease status. The study suggests that the shoulder should be given attention in patients with newly diagnosed rheumatoid arthritis, and that both tenderness and shoulder function should be evaluated.

Evaluation of a structured multidisciplinary day care program in rheumatoid arthritis. A similar effect in newly diagnosed and long-standing disease.

The present study evaluated a multidisciplinary structured day-care programme in patients with rheumatoid arthritis of less than 2 years (n = 41) and more than 2 years disease duration (n = 46). During the 3 week intervention, outcome measures reflecting disability (HAQ, SOFI), the patient's perception of disease and pain (VAS for patient's global assessment and pain), Ritchie articular index (RAI), a 44 swollen joint count, and overall disease activity (DAS) improved significantly in the group as a whole. The improvements remained significant after 15 weeks and were of a similar magnitude in the patient groups with short and long disease duration. At week 3 and 15, the ACR and the EULAR criteria for individual response, for the total study group was fulfilled by 28% and 26%, and 36% and 52% respectively. Evaluation of a subgroup 6 weeks prior to admission indicated that the outcome measures were stable at the time of the intervention. Furthermore, administration of intraarticular glucocorticosteroids (GC) could only partly explain the observed improvement. This uncontrolled observational study supports that a multidisciplinary day-care rehabilitation program is beneficial and feasible for patients with rheumatoid arthritis of both short and long duration.

A problem-based education program for patients with rheumatoid arthritis: evaluation after three and twelve months.

OBJECTIVE: To develop and evaluate the effect of a new arthritis education program based on a previous study. METHODS: One hundred individuals with established rheumatoid arthritis randomized to an intervention group or a control group completed self-report questionnaires. RESULTS: Three months after the education program the patients in the intervention group had increased their knowledge about their disease. They reported increased practice of exercise and joint protection and reduction of disability and pain. After 12 months, increased knowledge and practice of joint protection was maintained. However, there was no longer any difference between the intervention group and the control group regarding reported pain, disability, and practice of exercise. At both intervals the individuals in the intervention group reported an increased ability to handle their pain and a reduction of problems with their disease. The control group remained stable except for a slight increase in pain. CONCLUSION: A structured patient education program had positive impact for 3 months, and some improvements were maintained for 12 months. We suggest that patient education should become an integrated part of the total management of rheumatoid arthritis.