Abstract
Physicians engaged in the treatment of rheumatoid arthritis (RA) must always squarely face the question whether the administered treatment provides relief to the patient. For this purpose they must evaluate the quality of life (QOL) of the patient. Evaluation of the effect of therapy is important not only in drug therapy and surgical treatment but also in therapeutic exercise. As for the methodology, the American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials (ACR core set) is available. Though it is said that the ACR core set incorporates the concept of QOL, it cannot be said to be adequate. In our evaluation of treatment effects, daily activity questionnaire (Shiino, 1996) and Mason method modified by Shiino are employed. In treatment for improving joint range of motion and strengthening muscle power, we have developed our unique evaluation criterion. Though the ACR 1991 revised criteria for the classification of global functional status in RA is meaningful, adequate clinical application has not been made.
We have made a study for 8 years on the arthritis impact measurement scale (AIMS-2), using as subjects 22 RA patients. The results of this study revealed that QOL tended to deteriorate gradually. In study of QOL, it is desirable to use AIMS-2 which has been employed internationally and has been studied for reliability and adequacy. However, it should be recognized that it is a test developed in the United States having a culture different from that of Japan. It is necessary not only to compare the total score but also to analyze the individual questions. In addition, with regard to QOL and the individual, it is possible to lead an independent life with self-care of the impairment. Physicians involved in the treatment of RA should have a good understanding of the concept of rehabilitation. Therefore, the relationship between the physician and the patient is important, with informed consent becoming increasingly valuable in the future. As man exists in society, studies from the standpoint of social psychology are necessary. In particular, analysis at 6 levels from the individual to the group is needed.
Lastly, in our survey on the relationship between the number of painful joints and QOL, a trend was observed for QOL to improve with decrease in the number of painful joints. Therefore, in the surgical treatment of multiple joint involvement, arthroplasty leading to complete removal of pain is strongly desired.
