AB0786 Self-reported disease burden is greater in spondyloarthritis than in rheumatoid arthritis patients according to multidimensional questionnaire (MDHAQ / RAPID3) scores, despite fewer females, who generally have higher scores on patient questionnaires

Abstract

BackgroundFemale patients generally have higher scores than males on most items on self-report questionnaires, including MDHAQ/RAPID3 (multi-dimensional health assessment questionnaire/routine assessment of patient index data)1. MDHAQ/RAPID3 was validated in patients with rheumatoid arthritis (RA), but is informative in all diseases studied, including spondyloarthritis (SpA)2. More SpA patients are men than RA patients, suggesting lower scores, but MDHAQ scores are higher in SpA than RA.ObjectivesWe compared self-report MDHAQ/RAPID3 scores in RA vs SpA patients according to gender.MethodsPatients who met classification criteria for RA or SpA (axial SpA and psoriatic arthritis) completed MDHAQ at a routine rheumatology visit. The MDHAQ includes 10 activities for physical function (FN) (8 identical to HAQ), scored 0-3, total 0-30, divided by 3 for a 0-10 score, 3 0-10 visual numeric scales (VNS) for pain (PN), patient global assessment (PATGL), and fatigue (FT), a 60-symptom checklist (ROS60) and a RADAI self-report of painful joints (0-48). RAPID3 is a 0-30 index of FN + PN + PATGL. Means and standard deviations (SDs) of age, education, and 7 MDHAQ scores were computed in patients with RA versus SpA, and in subsets of female versus male patients with either RA or SpA. Unadjusted differences were evaluated using Student’s t and chi-square tests; mean differences were adjusted for age, gender and education using analysis of covariance.Results170 patients were studied, 102 with RA and 68 with SpA. 82% of patients with RA and 47% of patients with SpA were female (p<0.001); age and education did not differ between the 2 groups (Table 1). All 7 mean MDHAQ scores analyzed were higher in patients with SpA than in those with RA, although only differences for FN were statistically significant (Table 1). Within both the RA and SpA groups, however, all 7 scores were higher in women than in men, statistically significant for PN, PATGL, RAPID3 and fatigue in RA, and only for fatigue in SpA. In analyses adjusted for gender, FN, PATGL, FT, and RAPID3 were statistically significantly higher in SpA than in RA (Table 1).Table 1.Mean differences in the MDHAQ scores between RA and SpA patients.Total, n=170 patientsRA, n=102SpA, n=68RA: Female(n=84)/Male (n=18)SpA: Female (n=32)/ Male n=36)Mean difference: RA–SpA (95% CIs)UnadjustedMean difference: RA–SpA (95% CIs)Adjusted for age, gender, and educationAge, mean (SD)58.8 (12.2)55.7 (12.2)Gender, female (%)84 (82.4%)32 (47.1%)*Years of education, mean (SD)11.8 (4.3)11.4 (3.7)MDHAQ variables, mean (SD)Physical function (0-10)2.4 (1.8)3.0 (2.1)2.5 (1.8)/ 1.9 (1.6)3.1 (2.0)/ 2.9 (2.2)-0.6 (-1.2, -0.02)-0.7 (-1.3, -0.05)Pain (0-10 VNS)4.5 (2.8)4.9 (3.0)4.8 (2.8)/ 3.3 (2.4)*5.5 (2.9)/ 4.4 (3.0)-0.4 (-1.3, 0.5)-0.8 (-1.7, 0.1)Patient global assessment (0-10 VNS)4.6 (2.8)5.3 (2.9)4.9 (2.8)/ 3.4 (2.6)*5.9 (2.8)/ 4.7 (3.0)-0.6 (-1.5, 0.2)-1.1 (-2.0, -0.2)RAPID3 (0-30)11.6 (6.8)13.3 (7.3)12.3 (6.8)/ 8.5 (6.1)*14.6 (7.2)/ 12.2 (7.3)-1.7 (-3.8, 0.4)-2.7 (-4.9, -0.5)Fatigue (0-10 VNS)4.2 (2.9)4.5 (3.1)4.7 (2.9)/ 2.0 (2.1)*5.5 (3.1)/ 3.6 (2.9)*-0.3 (-1.2, 0.6)-1.0 (-1.9, -0.04)Self-report RADAI painful joint count (0-48)12.4 (11.0)13.4 (11.9)13.2 (11.4)/ 8.6 (8.5)15.6 (13.1)/ 11.5 (10.6)-1.0 (-4.5, 2.4)-2.2 (-5.8, 1.4)60-symptom checklist (0-60)12.6 (10.0)15.2 (10.9)13.3 (10.3)/ 9.4 (7.8)16.0 (10.3)/ 14.6 (11.6)-2.6 (-5.8, 0.6)-2.5 (-5.8, 0.7)*= p<0.05.ConclusionThe self-reported disease burden measured by MDHAQ / RAPID3 was higher in patients with SpA than in those with RA, despite having a lower proportion of women, who generally have higher scores on all patient self-report questionnaires, including MDHAQ/RAPID3, within both the RA and SpA groups. Gender differences may lead to underestimation of the greater disease burden in SpA compared to RA.