Difficulty driving and the use of driving adaptations are common in patients with rheumatoid arthritis (RA), according to study results published in Arthritis Care and Research.
Currently, there is no consensus on the impact of RA on patients’ driving ability or driving-related safety, including the occurrence of motor vehicle crashes. Researchers conducted a systematic review to identify whether RA is associated with driving ability and to determine if patients with RA use assistive devices or modifications to improve driving ability. Literature searches were performed using the Cochrane library, CINAHL, EMBASE, MEDLINE, PREMEDLINE, PsycINFO, Google Scholar, and Scopus.
An initial search yielded 1935 manuscripts with publication dates from 1976 to 2015, 22 of which were included in the present study. Most prior studies were cross-sectional, and included a sum total of 6285 participants with RA (average age range: 47 to 63 years; mean RA duration: 12 years).
In 4 studies included in the systematic review, researchers assessed the prevalence of motor vehicle crashes among drivers with RA and reported variability in the prevalence of crashes in this patient population. Researchers from a 1976 study, however, reported “with statistical significance” that people with RA in Finland were “involved in fewer [motor vehicle crashes] than their age-matched controls.” The RA group in this study drove less frequently and drank significantly less alcohol compared with the control group.
Researchers of 6 of the studies included in the review reported on patients with RA who were able to drive, but who experienced “at least some level of difficulty.” Researchers of 7 studies reported on patients with RA who were completely unable to drive. A German study that surveyed patients with RA reported that they drove vehicles “’with some effort’ or ‘with a lot of effort.’” Another study from 2005 found that 58% of 520 patients with RA felt that RA limited their driving ability, while another 8% were unable to drive at all.
The researchers noted that one study from New Zealand, published in 1991, reported on the results of an independent driving assessment, which found that 7 of 37 patients with RA had ‘unsatisfactory driving ability’ without assistance.”
Researchers of 3 studies addressed the implementation of driving adaptations to assist drivers with RA. In these studies, 9 of 25 drivers deliberately purchased cars with power-assisted steering or automatic gear boxes, 8 of 30 drivers made adaptations to their vehicles, and 12% of 476 surveyed patients reported using assistive devices.
Researchers noted that 2 studies specifically examined people with RA who rely on the assistance of others for transportation. One of these studies, conducted in Australia in 2002, found that 15% of patients received assistance from family or friends, a “significant independent predictor” of total expenditure; the other study reported that 17% of patients with RA received personal assistance with transit.
In terms of general transportation, 4 of the studies reported on patients who experienced broad difficulties in “getting around in the community,” with 1 study correlating this difficulty to a higher self-reported pain score.
Study limitations included the variability of RA severity and affected joints, which can be difficult to capture across studies, the nature of causal inferences that can be made due to the cross-sectional nature of the included studies, and a lack of generalizability across cultures.
“There is a scarcity of data that quantitatively relates RA to driving ability or related safety outcomes,” the researchers concluded. “Given the importance of automobile driving as an instrumental activity of daily living, further investigation of driving ability and potential driving modifications in the setting of RA are needed.”
Zhou DJ, Mikuls TR, Schmidt C, et al. Driving ability and safety in rheumatoid arthritis: A systematic review [published online January 7, 2020]. Arthritis Care Res. doi: 10.1002/acr.24137