Patient-completed health status instruments currently available for use with rheumatoid arthritis (RA) patients lack adequate reliability and responsiveness, making them unsuitable for use as outcome measures in clinical trials. A search of the literature failed to identify a quality of life (QoL) instrument specific to RA. The present study was designed to be the first stage in the development of such a measure. Qualitative interviews were held with 50 RA patients, 25 in the UK and 25 in The Netherlands. The interviews indicated that RA has a detrimental effect on many areas of life, including moods and emotions, social life, hobbies, everyday tasks, personal and social relationships, and physical contact. Transcripts of the interviews formed the source of items for the RAQoL, the first RA-specific QoL instrument.

The present study was designed to test the psychometric properties of the RAQoL, a rheumatoid arthritis (RA)-specific quality of life (QoL) instrument. All stages of the development were conducted simultaneously in The Netherlands and the UK. The content of the draft measure was derived from qualitative interviews with RA patients in both countries. The final version of the RAQoL has 30 items with a 'yes'/'no' response format and takes 06 min to complete. Both language versions have high internal consistency and test-retest reliability (q0.9), and good sensitivity to discriminate between groups with various disease activity and severity. Given the excellent psychometric properties of the new instrument, it will prove to be a valuable tool for assessing quality of life in clinical trials and for monitoring patients in routine clinical practice.

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Moderate or high-intensity weight-bearing exercises are safe with respect to disease activity and radiologic damage of the hands and feet. In the absence of sufficient data on exercise and radiologic progression of the large joints, patients with significant radiologic damage of the large joints should not be encouraged to participate in moderate to high-intensity weight-bearing exercise unless individualized to protect affected joints. A broader dissemination of the effectiveness and safety of moderate and high-intensity exercise for patients with rheumatoid arthritis is needed among rheumatologists, physical therapists, and patients.