Katz PP et al. (2006) Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis. Ann Rheum Dis 65: 763–769

Rheumatoid arthritis (RA) is associated with functional limitations, which can lead to disability. Disability influences both patients' physical functioning and psychological wellbeing, but previous studies have only evaluated RA disability in relation to employment and daily living. Katz et al. have confirmed the link between functional limitation and disability; however, they found that patients' day-to-day activities were less affected by RA than their leisure and social activities. It remains unclear whether patients voluntarily relinquish leisure activities in favor of obligatory ones.

Katz et al. evaluated data from annual telephone interviews of 548 individuals with RA who were enrolled in a US panel study. The authors assessed disability in relation to 26 valued life activities: 'obligatory' activities included self care, walking and using transport; 'committed' activities included paid work, household responsibilities and family care; and 'discretionary' activities included leisure and social activities. Participants rated the difficulty of performing the 26 activities (activities unimportant to the individual were not scored). Functional impairment was assessed using the Heath Assessment Questionnaire.

Committed (heavy housework, repairs, paid work) and discretionary (gardening, physical activity and hobbies) activities were most affected by RA, and were also rated most difficult to perform. By contrast, obligatory activities were rated least difficult, and were least affected by RA. Almost every patient reported that at least one activity was affected by RA (committed or discretionary activities in >90% of patients, and obligatory activities in 68%). Almost half were unable to undertake at least one activity—principally in the discretionary category.