RESPONSIVENESS OF KEITEL FUNCTIONAL INDEX COMPARED WITH LABORATORY MEASURES OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS |
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| Authors: | KALLA, A. A. SMITH, P. R. BROWN, G. M. M. MEYERS, O. L. CHALTON, D. |
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| Affiliation: | *Department of Medicine, Rheumatic Diseases Unit, Groote Schuur Hospital and University of Cape Town
!["{dagger}"]("/math/dagger.gif") Biostatistics Institute, South African Medical Research Council, Parow, Cape South Africa |
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| Abstract: | This study compares functional changes to change in measuresof disease activity following the introduction of slow-actinganti-rheumatic drugs (SAARD) in patients with active rheumatoidarthritis (RA). Clinical and laboratory variables were simultaneouslymonitored at 6-monthly intervals, over approximately 18 months.Function was measured by a performance testing, the Keitel functionindex (KFI), which was divided into sections representing smalland large joints [and (HFI); wrist (WFI) and limb function index(LFI)]. One-hundred-and-fifteen patients were studied, of whom21 were male. The mean age of the subjects was 49 yr (s.D. ±12) and mean duration of disease 7 yr (S.D. ± 7). Themean KFI at entry was 38 (S.D. ± 18) while at the endof the study it was 31 (s.D. ± 17) (P < 0.0001). Thechange in KFI following therapy correlated with the change inRitchie articular index (RAI) (r = 0.4; P < 0.0001), earlymorning stiffness (EMS) (r = 0.3; P = 0.004), swollen jointcount (JC) (r = 0.4; P = 0.0005). C-reactive protein (CRP) (r= 0.2; P < 0.05) and Lansbury systemic index (LSI) (r = 0.35;P = 0.002), but not with change in Westergren erythrocyte sedimentationrate (ESR) or change in time to onset of fatigue. Multiple regressionanalysis showed that 32% of the variation in KFI at the endof the study could be predicted by a combination of ESR, sulphasalazinetherapy, RAI, disease duration and chloroquine treatment atonset (P < 0.05). When HFI at end of study was the dependentvariable, 21 % of the variation could be predicted by a combinationof ESR, CRP, Lansbury systemic index and JC at onset (P <0.05). The duration of disease did not significantly influencethe potential for change in functional status. This study showedthat detailed measurement of function is important in assessingRA activity. Functional impairment in RA is a dynamic processinfluenced by changes in clinical disease activity with treatment. KEY WORDS: Keitel function index, Disease activity, Outcom, Hand function index |
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