Abstract
The SF-SACRAH was developed to assess the involvement of the hand in rheumatoid arthritis (RA) and hand osteoarthritis (HOA) patients in daily clinical routines. In this pilot study, its sensitivity to change will be assessed longitudinally, and preliminary thresholds for patient relevant changes are derived. Ninety-nine outpatients suffering from HOA (n = 55) or RA (n = 44) completed the SF-SACRAH once initially. After approximately 3 months, patients repeated the SF-SACRAH. At both visits, patients rated their satisfaction (PATSAT) with the state of their disease (1 = very good to 5 = unsatisfactory). For assessing its sensitivity to change, SF-SACRAH changes in patients with stable, improving, or worsening conditions according to PATSAT were calculated in HOA and RA patients. The respective medians and highest values were used to estimate patient relevant variation values. SF-SACRAH changes and positive or negative PATSAT changes in HOA as well as RA patients were analyzed by applying the Kruskal-Wallis test. In RA patients, the DAS28 was also calculated. Spearman's rho was calculated to correlate SF-SACRAH changes with the EULAR response criteria. In HOA and RA patients, a statistically high correlation between PATSAT changes and SF-SACRAH values was revealed (p < 0.0001 in HOA and p < 0.01 in RA patients, respectively). The median changes in SF-SACRAH in patients with improving, stable, or worsening conditions according to PATSAT were HOA patients: PATSAT improving: ΔSF-SACRAH -1.6, PATSAT stable: ΔSF-SACRAH +0.8, PATSAT worsening: ΔSF-SACRAH +1.0; RA patients: PATSAT improving: ΔSF-SACRAH -0.9, PATSAT stable: ΔSF-SACRAH +0.2, PATSAT worsening: ΔSF-SACRAH +0.8. In RA patients, there is a moderate, but significant, correlation between DAS28 EULAR response criteria and SF-SACRAH changes (ΔDAS28 improving >0.6: ΔSF-SACRAH -0.4, ΔDAS28 <0.6: ΔSF-SACRAH +0.0, ΔDAS28 worsening >0.6: ΔSF-SACRAH +0.5; r = 0.433, p < 0.01). The SF-SACRAH constitutes a reliable tool for the assessment of hand impairment in patients with chronic rheumatic diseases. It proved to be sensitive to change in this short-term evaluation in both HOA and RA patients. Additionally, preliminary patient variation values for improvement (-1.60) and deterioration (+1.0) could be derived.
Highlights
Hand osteoarthritis (HOA) and rheumatoid arthritis (RA) are the disorders seen in routine rheumatology practice that most frequently lead to impaired hand function
We developed a Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH) [3], which, alongside the Australian/ Canadian osteoarthritis hand index [4], appeared to show the lowest diversity ratio and the highest percentage of linked internal classification of functioning, disability, and health in the available questionnaires for HOA [5]
Fifty-five patients suffering from HOA and 44 patients suffering from RA completed the SF-SACRAH questionnaire during two consecutive appointments at the outpatient clinic
Summary
Hand osteoarthritis (HOA) and rheumatoid arthritis (RA) are the disorders seen in routine rheumatology practice that most frequently lead to impaired hand function. We developed a Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH) [3], which, alongside the Australian/ Canadian osteoarthritis hand index [4], appeared to show the lowest diversity ratio and the highest percentage of linked internal classification of functioning, disability, and health in the available questionnaires for HOA [5]. None of these questionnaires meet the requirements for use in daily clinical routines, as they are often comprised of too many questions, are too difficult or time consuming to calculate, or both. This makes it easy to use for non-rheumatologists
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