EPIDEMIOLOGY AND OUTCOME OF RHEUMATOID ARTHRITIS CASES MANAGED AT HAYAT SHAHEED TEACHING/ KHYBER TEACHING HOSPITAL PESHAWAR, PAKISTAN.1998

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How to cite this Thesis/ Dissertation:
EPIDEMIOLOGY AND OUTCOME OF RHEUMATOID ARTHRITIS CASES
MANAGED AT HAYAT SHAHEED TEACHING/ KHYBER TEACHING HOSPITAL
PESHAWAR, PAKISTAN. (Thesis). Authors: Muhammad Saaiq, Muhammad Asghar
Khan, Muhammad Riaz, Gul Hassan, Muhammad Qadeem, Musharaf Kamal Khan,
Muhammad Jamshed. Department of Community Medicine, Khyber Medical College
Peshawar, Pakistan. 1998.
TITLE:
EPIDEMIOLOGY AND OUTCOME OF RHEUMATOID ARTHRITIS CASES
MANAGED AT HAYAT SHAHEED TEACHING/ KHYBER TEACHING
HOSPITAL PESHAWAR
CORRESPONDING AUTHOR & EDITOR-IN-CHIEF:
MUHAMMAD SAAIQ SELJUKI
4th
Year MBBS,
Khyber Medical College, Peshawar
muhammadsaaiq5@gmail.com
ABSTRACT
Background: The rheumatic disorders constitute a major cause of disability throughout the
world. Rheumatoid arthritis (RA) is on the top of the list of such disorders. It puts a significant
degree of socio-economic stress and burden on all societies, both developing and developed.
The resulting disabilities vary according to the severity and progression of the disease, i.e. the
sufferer may become moderately restricted, incapacitated or fully dependent on others. His
performance is sadly affected and he can’t add his share to the country’s economy effectively. If
the sufferer is the sole earner of the family, the whole family may encounter economic death.

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For effective prophylaxis and treatment of RA, there is dire need of more research and
advancement in the areas of epidemiology, risk factors identification, genetics, immunology,
pharmacology, mass awareness and education, and rehabilitation of the disabled sufferers. This
need is all the greater owing to changing patterns of morbidity and mortality, resulting from
quick urbanization, changes in lifestyles, increasing life expectancy etc.
Objective: To document the clinical presentation and outcome of RA in The North West
Frontier Province(i.e. Khyber-PakhtoonKhwa) and adjoining areas which constitute the
catchment areas of Khyber teaching hospital Peshawar.
Study Design: Clinical Observational study
Place and Duration: Department of Medicine, Khyber teaching hospital Peshawar from May
01, 1996 to April 30,1997.
Methodology: All adult rheumatoid arthritis patients of either gender and all ages who were
managed at the Department of Medicine, Khyber teaching hospital Peshawar during the study
period were included by convenience sampling. Patients who had rheumatic problems but did
not qualify the ARA Criteria were excluded. Also those patients who did not consent to
participate in the study were excluded. The diagnosis of RA was made if the patient had
features of inflammatory arthritis of at least 6 weeks’ duration, according to the American
Rheumatism Association criteria (ARA Criteria 1988 revision). Diagnosis was made if 4 or
more of the following criteria were present. 1-arthritis of ≥ 3 joints, 2-arthritis of hand joints, 3-
symmetrical arthritis, 4-rheumatoid nodules, 5-rheumatoid factor, 6- radiological changes.

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A well designed Proforma was used for data collection. The data were analysed statistically to
measure the objectives.
Results:
Out of a total of 116 patients, there were 81 females while 35 males.
Majority (60.5%) patients belonged to the age group 31-60 years. The average age for RA
onset was 46.2 years for males while 42 years for females.
About 6% of the patients had a positive family history of the disease.
21.55% patients were unmarried while the remainder were married.
62.07%, 11.21% and 26.72% patients belonged to urban, suburban and rural areas respectively.
60% patients had hosing of modern style, 1.72% patients were homeless living under shadows
of tents, the remainder had old fashioned housing.
Factors such as educational status, occupation, income, diet, addiction, general health, exercise,
racial origin, and religion were found to have no association with the disease.
Onset and exacerbation of symptoms was seen in 19% of the patients in the month of May (
which marks the start of summer in the region). Overall 55.2% patients presented for
hospitalization in summer months of May through September.
The pattern of onset of RA was insidious in 65.52% cases, oligoarticular in 13.8% cases,
polyarticular in 8.62% patients, acute in 8.62% cases, and palindromic in 3.45% cases.

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Presentation with typical form of RA was found among 45.22% patients. Systemic involvement
was found in 45.7% patients.
66.38%, 25% and 8.62% patients had grade II, III and IV disability respectively.
25%, 11,2%, 5.17%,1.72%, 1.72%, 0.86% and 0.86% patients had complications of RA in the
form of joint failure, systemic infection, amyloidosis, joint infection, depression, osteoporosis
and spinal cord compression respectively.
Simple analgesics, antimalarials, NSAIDS, DMARDS, and steroids were used in various
combinations as the treatment of choice.
84.5% patients reported symptomatic relief with treatment, 12.07% reported partial
symptomatic relief, while 3.45% patients reported no relief.
Corrective surgeries were performed in 1.72% of the patients. There was no in-hospital
mortality.
Conclusion: RA is a chronic progressive disorder affecting small and large synovial joints.
Majority of the patients had insidious onset. Female patients outnumbered males. Majority of
the patients were in their 3rd
,4th
and 5th
decades of their life. Only small percentage of patients
had positive family history of the disease. More patients were from urban than rural areas.
Majority of the patients had onset/ exacerbation of RA in summer season months. Factors such
as educational status, occupation, income, diet, addiction, general health, exercise, racial origin,
and religion were found to have no association with the disease. The disability that resulted

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from the progressive disease put significant socio-economic burden on the patients and their
families. Unfortunately the available treatment regimens did not provide satisfactory results and
majority of the patients ultimately suffered mutilating disabilities of hands and feet as a result of
the progressing disease.
Key words: Rheumatoid arthritis. Disabilities from arthritis, American Rheumatism
Association criteria (ARA Criteria).

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Thank You