Clin Rheumatol (2007) 26: 24–29 DOI 10.1007/s10067-006-0215-4 ORIGINAL ARTICLE Romela Benitha . Mohammed Tikly Functional disability and health-related quality of life in South Africans with rheumatoid arthritis and systemic lupus erythematosus Received: 18 September 2005 / Revised: 16 January 2006 / Accepted: 17 January 2006 / Published online: 15 March 2006 # Clinical Rheumatology 2006 Abstract There is a paucity of data on the impact of chronic rheumatic diseases on functional disability and overall health-related quality of life (HRQOL) in Africans. Materials and methods: We compared Black South Africans (BSA) with rheumatoid arthritis (RA) (n=50) and systemic lupus erythematosus (SLE) (n=50) to geographically and ethnically matched controls cared for at a tertiary care facility. The modified health assessment questionnaire (mHAQ) and Medical Outcome Study short- form 36 (SF-36) scores and indices of disease activity and organ damage were collected from each group. Results: Compared to the controls, both the RA and SLE groups fared significantly worse in respect of all the domains and summary scales of the SF-36. Compared to the SLE group, the RA group scored significantly worse with respect to the mHAQ disability index (mHAQ-DI), physical function and bodily pain (BP) SF-36 subscales, and SF-36 summary physical component score (SF-PCS). In the RA group, both the mHAQ-DI and SF-PCS correlated strongly (p<0.005) with the tender joint count, patient global assessment, 28- joint composite disease activity score, physician global assessment, and pain score. The SF-PCS showed only a weak inverse correlation with the swollen joint count (r=-0.29, p<0.05). In the SLE group, the systemic lupus erythematosus disease activity index correlated inversely best with the SF-36 general health subscale (r=-0.56, p<0.0001) and, to a lesser extent, with the mental health, BP, and vitality subscales, and SF-PCS and SF-mental component summary scores. Conclusion: Both RA and SLE have profound effects on HRQOL in BSA, with BP and physical disability particularly worse in RA patients. Disease activity, rather than organ damage or socio- demographic characteristics, correlates best with certain aspects of functional disability and HRQOL in both RA and SLE. Further longitudinal studies are needed to assess the clinical utility of measures of functional disability and HRQOL in this population. Keywords Africa . Functional disability . Quality of life . Rheumatoid arthritis . Systemic lupus erythematosus Functional disability and overall health-related quality of life (HRQOL) measures have become an essential part of the overall assessment of patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In the case of RA, measuring functional disability not only provides a patient-oriented outcome assessment in routine clinical practice but also predicts mortality and work disability. Life expectancy is reduced in RA by between 5 and 10 years [1] and a 5-year survival for patients with American College of Rheumatology (ACR) functional class IV disability is comparable to those of patients with triple vessel coronary artery disease or stage IV Hodgkins disease [2]. In SLE, with steady improvement in survival over the last few decades, the long-term objectives of treatment have expanded to include improvement in HRQOL and reduc- tion of physical disability [3]. Disease-specific and generic HRQOL questionnaires such the modified health assessment questionnaire (mHAQ) [4] in RA and the medical outcome study short form 36 (SF-36) [5], a generic HRQOL instrument, have been widely used in rheumatic illnesses. Numerous studies have shown that both socio-economic and ethnicity influence morbidity in RA and SLE [3, 6–8]. Contrary to the common notion that RA is mild and SLE is relatively rare in Africans, studies conducted by us and other groups show that both of these diseases are associated with significant morbidity and mortality [9–11]. The majority of South Africans rely on a state-funded health care system that is under-resourced. Access to health care for the indigent patient is variable, being best in the large metropolitan areas and worst in the remote regions of the country [12]. This often results in delayed diagnosis and R. Benitha . M. Tikly (*) Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa e-mail: tiklym@medicine.wits.ac.za Fax: +27-11-938-8738