Household work disability of Arab housewives with rheumatoid arthritis

There have been few studies on the impact of rheumatoid arthritis (RA) on household work, and none has been done in a setting where female unemployment is normative. The typical Israeli Arab woman is nearly always unemployed, poorly educated, has low financial resources, and is fully responsible for maintenance of the household work. In this study, we attempted to determine whether social-economic factors or medical evaluation best predicts household work disability. Arab housewives with RA that are followed up regularly with disease duration > 6 months were recruited consecutively from three outpatient clinics in northern Israel. These patients had to answer a questionnaire regarding demographic and social data, performance of typical household activities, patient-family relationship, and disease parameters. Information from the medical charts was also obtained on all the patients regarding erythrocyte sedimentation rate (ESR), C-reactive protein, tender joint count (28 joints), and swollen joint count (28 joints), all from the last visit. Information was obtained also on bone erosions, rheumatoid factor positivity, and disease duration. Those who could not perform at least one household activity were defined as being disabled and compared to those who have no such disability. Forty-eight patients completed the study, and 33 (68.8%) patients were disabled (unable to do at least one household activity). The disabilities in the 33 patients included total inability to clean the house in 30 (91%), inability to wash the floor in 28 (84.8%), inability to take care of the children or husband in 18 (54.5%), inability to wash the dishes in 15 (45.5%), and inability to cook in 10 (30.3%). There were three variables that significantly added to a logistic regression model predicting disability; husband's salary, the number of kids in the family, and the ESR. This model was excellent with the area under the receiver-operator curve (ROC) of 93.1%. Substituting years of symptoms for ESR also resulted in an excellent model with the area under the ROC of 90.8%. None of the other variables including findings on physical examination significantly added to the model. We conclude that socio-economic factors are highly predictive of homemaking disability in Arab women with RA and more predictive than the clinical examination. Further studies in other cultures are needed to substantiate our results.