Assessment of Functional Disorders of the Upper Limbs in Patients with Rheumatoid Arthritis

Abstract

The purpose of the study was to assess functional disorders of the upper limbs in patients with rheumatoid arthritis using the Boston Carpal Tunnel Questionnaire. Materials and methods. To assess the functional status of the affected upper limbs of patients with rheumatoid arthritis, the Boston Carpal Tunnel Questionnaire was used, which consists of two scales: the Symptom Severity Scale and the Function Status Scale, which were filled out by the patients themselves. The study was conducted on the basis of rheumatology department of the Municipal Enterprise “Yuriy Semeniuk Rivne Regional Clinical Hospital” in Rivne during the period from 2016 to 2018. 216 patients took part in the examination, of which 178 (82%) were women and 38 (18%) were men. The patients’ age is from 25 to 59 years old (average age is 46 ± 0.24). The inclusion criteria were: the presence of an established diagnosis of rheumatoid arthritis based on the ACR/EULAR 2010 criteria, and in accordance with the Order of the Ministry of Health of Ukraine dated April 11, 2014 No. 263 “Unified clinical protocol of primary, secondary, of tertiary medical care and medical rehabilitation of patients with rheumatoid arthritis”, the presence of informed consent of patients to participate in the study. Patients' rights were respected in accordance with the Declaration of Helsinki “Ethical Principles of Medical Research Involving Human Subjects” developed by the World Medical Association, “Universal Declaration of Bioethics and Human Rights (UNESCO)”. Results and discussion. During the initial examination, it was found that the majority of patients had moderate (20.3%) and severe pain (16.6%) in the affected upper limbs (hands / wrists), which in the last two weeks had caused the patients to wake up at night: once – 10.6% of patients, 2–3 times –15.7% of patients. During the day, 20.3% of patients complained of moderate pain in a hand / wrist, and 17.5% of people were bothered by severe pain. The majority of patients (15.7%) noted that the pain lasted from 10 to 60 minutes. As for functional disorders, the greatest difficulties for patients occurred when buttoning clothes – 45.3%, doing household chores – 39.8%, and opening a bottle – 36.1% of patients. Manifestation of local symptoms of damage to the carpal tunnel affects the general physical and psychological condition of the patient. The patient loses work capacity, concentration, and the quality of his / her life decreases. Conclusion. Considering the above results, we are convinced of the need to implement the concept of physical rehabilitation/therapy, which would be able to reduce the level of existing functional disorders and improve the quality of life for patients with rheumatoid arthritis

The effect of a physical therapy programme on the condition of upper limb muscles in patients with rheumatoid arthritis

“…24 The research results presented above confirm the hypothesis that in patients with rheumatoid arthritis, as a result of a long-term inflammatory process, pain syndrome, and a significant decrease in muscle strength, the function of the upper limbs deteriorates and, accordingly, their quality of life. 15,[23][24][25]…”

“…13 An early and permanent sign of rheumatoid arthritis is progressive muscle atrophy, which leads to sharp decline in strength, muscle weakness and is accompanied by a significant decrease or cessation of the patient's physical activity. 14,15 Numerous clinical data indicate a high degree of reduction in physical activity of patients with rheumatoid arthritis due to impaired mobility and functional insufficiency of joints. 1,10,11,16,17 According to most authors, in order to increase the effectiveness of drug treatment, a special role is given to physical therapy, which should be an integral part of the comprehensive restorative treatment of patients with rheumatoid arthritis.…”

“…6,9,13,14,18,19 As of today, there is a need for the development and implementation of effective physical therapy technology, which would include an individual approach to the use of innovative restorative physical therapy measures, objective methods of evaluating the effectiveness of the measures and predicting the results. 4,15,20,21 The lack of such works devoted to a personalized approach to physical therapy of patients with rheumatoid arthritis determined the relevance of the presented work.…”

Оцінка Стану Здоров’я Пацієнтів Із Ревматоїдним Артритом У Результаті Впливу Програми Фізичної Терапії

“…населення. Жінки хворіють у 2-5 разів частіше, ніж чоловіки [4]. Це зумовлено тим, що недостатніми є профілактичні заходи, спрямовані на раннє виявлення захворювання, дуже повільно впроваджуються сучасні методи діагностики та лікування ревматоїдного артриту, недостатня кількість медикаментів та обладнання [5].…”

“…У результаті запального процесу верхніх кінцівок пацієнтів із ревматоїдним артритом спостерігається зменшення амплітуди рухів у суглобах, зниження м'язової сили [9]. Ранньою та постійною ознакою ревматоїдного артриту є прогресуюча атрофія м'язів, що призводить до різкого занепаду сил, м'язової слабкості та супроводжується значним зменшенням або припиненням рухової активності пацієнта [10; 11].…”