الفهرس 
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Abstract
Aim of the work
To study the variability, assessment and determinants of disability in Rheumatoid arthritis outpatients under rheumatological care, using a biopsychosocial cross cultural model.
Conclusions
The variability of rheumatoid arthritis
1- Rheumatoid arthritis is a variable is a variable disease in its occurrence and manifestations in time and place.
2- Rheumatoid arthritis starts at a younger age in Egyptian patients than Dutch patients.
3- Egyptian rheumatoid arthritis patients have a disease of equivalent clinical, radiological and serological severity when compared to Dutch patients matched in age, sex and disease duration. Egyptian patients have a more active ongoing disease process however, manifested in more pain and clinical and laboratory disease activity.
4- Egyptian rheumatoid arthritis patients are more disabled than matched Dutch patients. Their higher disability is exhibited in fine activities of the hands and in sexual limitations, but not in walking and outdoor activities.
The assessment of disability
1- The health assessment Questionnaire disability index is a unidimensional measure of disability that that is intrinsically valid, reliable and cross culturally stable when minor cultural adaptations are made. Inclusion of sexual activities in the index increases its reliability, and does not result in low patient response when administered in an interview by a physician.
2- The Arabic and Dutch versions of the HAQ-DI posses a similarly high degree of internal consistency, as well as equivalent criterion, content, construct and Factorial validities.