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Chronic Disease

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People with arthritis and lupus have less functionality after strokes than others without those conditions

Recovery from the damage a stroke causes often requires stays in inpatient rehabilitation centers. There, staff members work to help patients regain their mobility or learn new techniques to complete daily tasks. People who suffer strokes, and also have conditions that cause joint pain and swelling, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), face even more hurdles during recovery, a new study finds.

Tracy U. Nguyen-Oghalai, M.D., of the University of Texas, and colleagues used a national database to identify 47,853 patients who received inpatient rehabilitation services after strokes from 1994 to 2001. Of those patients, 368 had RA and 119 had SLE. Researchers used ratings from the Functional Independence Measure (FIM) instrument that gauges the amount of assistance a person needs to complete 18 tasks. Ratings can range from 18, meaning total dependence, to 126, indicating total independence.

On admission to inpatient rehabilitation, FIM instrument ratings were similar for stroke victims who had and did not have RA or SLE. However, at discharge, patients with RA had an average FIM instrument rating of 85.8 compared with 87.8 for patients who did not have RA or SLE. At followup visits between 3 and 6 months, ratings for patients with RA continued to be lower (95.9 vs. 99.6). Outpatient therapy after discharge may further improve functionality for patients with RA, the authors suggest.

Stroke patients with SLE tended to be 17.5 years younger than patients without RA or SLE, but their age did not provide an advantage in their recovery. They did not return home more often than older people with no RA or SLE felled by strokes, nor did they have better functionality at discharge or at followup compared with that group.

An earlier study indicated that people with SLE who have strokes end up in skilled nursing facilities at the same rate as older patients after experiencing strokes. Because of these poorer outcomes, more aggressive preventive strategies to combat cardiovascular disease may be needed to prevent these people from suffering strokes, the authors suggest. The study was funded in part by the Agency for Healthcare Research and Quality (HS11618).

See "Functional outcome after stroke in patients with rheumatoid arthritis and systemic lupus erythematosus," by Dr. Nguyen-Oghalai, Helen Wu, Ph.D., Terry A. McNearney, M.D., and others in the July 15, 2008, Arthritis & Rheumatism 59(7), pp. 984-988.

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