Rheumatoid arthritis (RA) is the most common chronic autoimmune systemic inflammatory arthritis, characterized by symmetrical joint synovitis and pain. It commonly affects the wrist and smaller joints of the hand, occurring in approximately 0.5–1% of the general population. Despite pain and deformities, individuals with RA continue to function in daily life—making it essential to understand how hand dysfunction impacts overall ability and quality of life.
The Importance of Hand Function in RA
The hand is the principal means by which an individual interacts with people and objects in the external environment. In patients with RA, reduced hand function can significantly limit independence and daily activities. The Grip Ability Test (GAT) is an Activity of Daily Living-specific tool used to evaluate hand function in RA patients. It assesses four types of grip: lateral pinch, five-finger pinch, pulp pinch, and transverse volar grip.
Measuring Disability and Quality of Life
The International Classification of Functioning, Disability and Health (ICF) provides a classification of health and health-related domains, describing changes in body function and structure. It uses a biopsychosocial model—an interaction of the medical and social models of health.
The WHO defines disability as an umbrella term covering impairments, activity limitations, and participation restrictions. In RA, disability is a consequence of pain, active synovitis, and joint damage—ultimately affecting Quality of Life (QOL), which can be assessed through the Health Assessment Questionnaire Disability Index (HAQ-DI).
Patients with RA can also be categorized using the revised criteria for classification of functional status by the American College of Rheumatology. The 30-item Disabilities of Arm, Shoulder and Hand (DASH) Outcome Measure is a self-reported questionnaire designed to measure physical function and symptoms in patients with musculoskeletal disorders of the upper limbs.
Why Assessment Matters
Despite pain and deformities, individuals with RA continue to function—causing secondary consequences on overall functioning. Evaluating the correlation between hand function, upper limb function, and quality of life provides valuable insight into the true impact of hand dysfunction on disability in RA patients, particularly within the Indian population.
Aims and Objectives of the Study
The aim of the study was to observe the correlation between the functional ability of the hand with upper limb function and quality of life in patients with RA. The objectives were to assess and correlate hand functional ability with upper limb function, hand functional ability with quality of life, and upper limb function with quality of life in RA patients.
Conclusion
The study concluded that in patients with RA, there is a moderate positive correlation between the functional ability of the hand and upper limb function, a moderate positive correlation between hand functional ability and quality of life, and a strong positive correlation between upper limb function and quality of life.
The impact of hand dysfunction on an RA patient’s functioning can lead to significant disabilities. Hand function disability poses one of the greatest obstacles to independent living, highlighting the need to incorporate newer techniques and approaches to assessment and treatment for enhancing upper extremity function.
Assessment using the GAT, DASH, and HAQ-DI tools can provide a quick and early insight into the debilitating effects of RA on functioning and disability. Early intervention can then be initiated to help limit joint damage and improve functional outcomes—ultimately preserving independence and quality of life for RA patients.
— Dr. Sanjay Agrawal
Leading Pharmaceutical Consultant and Editor-in-Chief of IJMToday
