Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Rheumatology and Rehabilitation

Background: Joint damage and disability in RA increases with disease duration, and progresses constantly over the first 20 years of RA. The link between damage and disability are stronger in late RA. The degree of damage shows the irreversible results of disease activity overtime, and joint damage is the most prominent feature of the disease outcome. Objective: This study was designed to compare the articular damage in groups of RA patients with different treatment regimens using Rheumatoid Arthritis Articular Damage (RAAD) score and to evaluate the parameters that correlate with this score. Methods: One hundred fifty adult rheumatoid arthritis patients (141 females and 9 males) were involved in this study. All patients were divided into three groups as regard their medications. Group 1 (60 patients on DMARD therapy), Group 2 (60 patients on DMARD and corticosteroid therapy) and Group 3 (30 patients on corticosteroid therapy). All patients were subjected to full history taking, clinical examination and laboratory and radiological investigations necessary for diagnosis of rheumatoid arthritis. Assessment of disease activity was done using the DAS-28 scoring system. Assessment of functional outcome using the Modified Health Assessment Questionnaire (MHAQ) score and measurement of articular damage using Rheumatoid Arthritis Articular Damage (RAAD) Score were done. Results: There was a statistically significant difference found in RAAD score between the three groups (P-value = 0.001), with higher score in group 3. They also revealed significantly different MHAQ and VAS scores (P-value = 0.001and P= 0.015 respectively). While the other clinical data (e.g., age, disease duration, disease activity, joint space narrowing in hands and feet, erosion in hands and feet and x- ray score showed no significant statistically difference between the three RA different groups. While RAAD score demonstrated no correlation with age, DAS score or VAS score in the present study, there was a negative significant correlation between RAAD score and age at onset of disease and tender joint count, and a positive significant correlation with disease duration, swollen joint count, MHAQ score, JSN in hands, JSN in feet, erosion in hands, erosion in feet and X-Ray Score

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