Activity and Severity of Rheumatoid Arthritis in Hannover/FRG and in One Regional Referral Center

Abstract

Between November 1984 and July 1988 a total of 8044 randomly selected German residents of the city of Hannover/FRG, aged 25 to 74, have been screened for rheumatic complaints by means of a postal questionnaire. An average 87% of the probands contacted returned completed questionnaires. Respondents with a “positive” questionnaire, i.e. suggestive of the existence of an inflammatory joint disease were invited for a rheumatological examination at the Hannover Medical School. 72% participated. 45 of a total of 1291 participants were identified as suffering from active or inactive, mostly rheumatoid arthritis.

This yields a minimum prevalence of 0.56% (+/-0.19%). The true prevalence is estimated to be 0.91% (99%-confidence interval 0.64-1.18). In 1985 and 1986103 German RA sufferers aged 25 to 74, all citizens of Hannover, were referred to our outpatient rheumatology clinic for a first consultation.

A comparison between the two groups revealed a higher disease activity in terms of “objective” criteria (joint swellings, ESR, rheumatoid factor) in the group of the referred patients as opposed to RA suffers from the community. Both groups were comparable in respect to “subjective” symptoms (morning stiffness, joint pain, pain intensity), functional capacity and degree of erosive joint lesions.

The rheumatological outpatient clinic at the Hannover Medical School, providing the only specialized service in the region, actually covers less than 20% of all RA sufferers within the municipal area of Hannover and less than 50% of those with a “classical” RA according to the ARA-criteria.

Key Words:

• Rheumatoid arthritis
• prevalence
• activity
• severity
• referral
• community effectiveness
• health services research