Functional status assessment of physical impairment in a community based population with rheumatoid arthritis: severely incapacitated patients are rare.

Objective. To determine the severity of impairment due to rheumatoid arthritis (RA) in a community based population. Methods. The level of impairment in the study group, which represented 88% of the subjects known to have RA in a rural community in Finland, was assessed using the Keitel function test (KFT), a series of 23 range of motion tasks, with score ranging from 96 (worst) to 0. Results. According to the KFT results, 10% of the subjects had severe impairment with a KFT score of 65-96. As to the different Keitel components, the mean hand functional index was 22.6 from a possible score of 42, and the mean lower limb function 8.9 out of 44. Conclusion. Our results showed that severely incapacitated patients with RA are rare in the community. The reasons remain speculative. Multidisciplinary care, including early and active treatment with disease modifying antirheumatic drugs and a high number of orthopedic operations may be an explanatory factor. Total joint replacement surgery of the large joints, performed in 19% of patients, may explain the absence of marked restriction in mobility and the divergence between the limitations in the upper and lower limb functions in this series.