Average Health Assessment Questionnaire Research Articles

P168 The impact of psoriatic arthritis on quality of life and lifestyle: a systematic review

Abstract Background/Aims Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects adults of all ages. It is common for patients to experience a wide variety of physical and psychological problems. The objective of this systematic review was to determine how PsA impacts a person's quality of life (QoL). Methods A systematic literature search of CENTRAL, CINAHL, AMED, EMBASE, Global Health, MEDLINE and PsycINFO databases was conducted on 28th May 2021. Title, abstract and whole text screening, and data extraction were completed by two independent authors. The primary outcomes of this study were PsA activity and severity, impact of PsA on lifestyle and QoL. As per the protocol (PROSPERO CRD42021257395), studies which reported at least one of these primary outcomes were included. The quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal criteria. Results Of the 20,316 papers identified by the search strategy, 42 papers which reported on at least one of the study primary outcomes were included in the review. 38 studies reported on PsA activity and severity, 26 on impact of PsA on lifestyle and 23 on QoL. 7 different measures were used to assess impact of PsA on lifestyle, including Health Assessment Questionnaire (HAQ) (n = 13), modified HAQs (n = 10), PsA impact of disease measure (n = 2), functional capacity ACR (n = 1), functional assessment of chronic illness therapy (n = 1), Bath ankylosing spondylitis functional index (n = 1) and a patient-directed question (n = 1). 13 papers reported an average HAQ score between 0.13 and 1.3 for PsA participants. Two studies which reported HAQ disability index compared PsA participants to other groups. Thus, the impact of disease on lifestyle is worse for PsA compared to psoriasis, rheumatoid arthritis and healthy controls, psoriasis. DAPSA and PASI were the most used disease activity scores in addition to various patient-reported outcomes. The average DAPSA was 15.5, suggesting that the majority of PsA patients have moderate disease activity. Although the average PASI (skin) score showed mild disease among the PsA (3.82) group, a high PASI score was associated with late/never minimal disease activity and obesity. 8 different measures were used to assess QoL, including Psoriatic Arthritis Quality of Life (n = 6, average), EQ-5D (n = 4), EQ-3D (n = 1), DLQI (n = 7), SF-36 (n = 3), SF-12 (n = 1), WHOQOL-BREF (n = 2), PSQI (n = 1), Rosenberg Self-Esteem Scale (n = 1) and Psoriasis disability index (n = 1). Except for QoL for skin (DLQI), PsA was associated with worse outcomes in all these measures, in comparison with spondylarthritis, healthy control and psoriasis only groups. Conclusion PsA significantly affects a patient's life and health-related QoL. The degree of activity and severity of the disease have a substantial impact. Therefore, for patients with high disease activity, specific management plans should be discussed and facilitated to maintain their mobility and functional abilities. Disclosure L. James: None. R. Suribhatla: None. L.H. Hailey: None. R. Amarnani: None. C. Bundy: None. D. McGagh: None. S. Kirtley: None. D. O'Sullivan: None. I. Steinkoenig: None. L.C. Coates: None.

Inflammatory profile of incident cases of late-onset compared with young-onset rheumatoid arthritis: A nested cohort study.

To describe the characteristics of patients between late-onset rheumatoid arthritis (LORA) with young-onset (YORA), and analyze their association with cumulative inflammatory burden. We performed a nested cohort study in a prospective cohort comprising 110 patients with rheumatoid arthritis (RA) and 110 age- and sex-matched controls. The main variable was cumulative inflammatory activity according to the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR). High activity was defined as DAS28 ≥ 3.2 and low activity as DAS28 < 3.2. The other variables recorded were inflammatory cytokines, physical function, and comorbid conditions. Two multivariate models were run to identify factors associated with cumulative inflammatory activity. A total of 22/110 patients (20%) met the criteria for LORA (≥ 60 years). Patients with LORA more frequently had comorbid conditions than patients with YORA and controls. Compared with YORA patients, more LORA patients had cumulative high inflammatory activity from onset [13 (59%) vs. 28 (31%); p = 0.018] and high values for CRP (p = 0.039) and IL-6 (p = 0.045). Cumulative high inflammatory activity in patients with RA was associated with LORA [OR (95% CI) 4.69 (1.49-10.71); p = 0.008], smoking [OR (95% CI) 2.07 (1.13-3.78); p = 0.017], anti-citrullinated peptide antibody [OR (95% CI) 3.24 (1.15-9.13); p = 0.025], average Health Assessment Questionnaire (HAQ) score [OR (95% CI) 2.09 (1.03-14.23); p = 0.034], and physical activity [OR (95% CI) 0.99 (0.99-0.99); p = 0.010]. The second model revealed similar associations with inflammatory activity in patients with LORA. Control of inflammation after diagnosis is poorer and comorbidity more frequent in patients with LORA than in YORA patients and healthy controls.

Anticytokine Treatment of Rheumatoid Arthritis: An Observational Report.

Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology, characterized by symmetrical arthritis, and deterioration of articular cartilage and epiphyses leading to progressive destruction and deformation of joints, resulting in disability. The purpose of this chapter is to evaluate the effects of treatment with anti-inflammatory biologic medication, Enbrel (Etanercept), during therapeutic rehabilitation in RA patients. The sample comprised 10 hospitalized patients (8 females and 2 males) of the mean age of 32.2±13.4years treated with Enbrel in 2008-2010. The drug was administered subcutaneously in a dose of 50mg once a week. Outcomes consisted of differences in the Disease Activity Score (DAS-28) and the degree of joint impairment based on the Health Assessment Questionnaire (HAQ) noted 2months after treatment onset. The average pre-/post-treatment DAS-28 score was 4.1/2.6, with improvement in 9 patients. The average HAQ score was 1.5/0.6, respectively. We conclude that treatment with Enbrel significantly reduces RA activity and improved joint impairment. The beneficial influence of the drug enabled an earlier commencement of physical rehabilitation, which may have a preventive bearing on the development of disability.

FRI0349 PSORIATIC ARTHRITIS AND CENTRAL OBESITY: STRONG ASSOCIATION WITH FUNCTIONAL DISABILITY AND A WORSE QUALITY OF LIFE

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with comorbidities like obesity, metabolic syndrome, and cardiovascular disease. Adipose tissue leads to a pro-inflammatory status in obese subjects. For this reason, central obesity may determine a worsening in both disability index or quality of life in PsA patients treated with biologic agents.Objectives:Our study aimed to evaluate the relationship between central obesity and disability index or the impact of the disease on quality of life in a real-world sample of PsA patients.Methods:A cross-sectional study was conducted. Patients with PsA were enrolled at the PsA clinic at the ARNAS Civico in Palermo (Italy) from March 2018 to December 2019. Clinical, pharmacological, anthropometric, laboratoristic variables, and patient-reported outcomes, including the Health Assessment Questionnaire (HAQ) and Psoriatic Arthritis Impact of Disease (PsAID) were evaluated. STATA 14.1 was used to perform statistical analysis.Results:A total of 143 outpatients aged 55.6 (47.7-63.7) affected by PsA, according to CASPAR criteria, were consecutively evaluated. The average years of illness were 10.8 (9.5-12.1). Patients were treated with biological therapy (81.3%), DMARDS (41.6%), small molecules (9.9%), or their combinations. Both sexes were equally represented. 71.9% of enrolled patients had central obesity (64.9% men and 78.1% women) with an average waist circumference of 104.2 (101.8 - 106.6) for women and 103.6 (100.0 -107.2) for men. Average HAQ was 1.05 (0.92 - 1.19), and data analysis showed 50.3% of patients with normal-mild functional disability, 30.1% moderate to severe disability, and 19.6% severe to very severe disability [Fig 1]. 51,7% of the sample had a high impact of the disease on life, according to the PsAID questionnaire [Fig 2]. A strong association was observed between functional disability measured by HAQ &gt;2 and central obesity [OR (95% CI) 16.94 (2.22 - 129.48); p &lt; 0.006]. Moreover, data analysis showed an association between high impact of disease on life (PsAID &gt;4) and central obesity [OR (95% CI) 3.33 (1.56 - 7.13); p&lt;0,002].Fig 1.Functional disability on PsA patientsFig 2.Impact of disease on PsA patients quality of lifeTable.Week 24 Treatment-Interaction Outcomes Adjusted by Sex and BMIConclusion:Our study demonstrated a high association between functional disability studied subjectively using the HAQ, the impact of the disease on patients’ quality of life using PsAID, and central obesity in Sicilian outpatients affected by PsA. Data suggest that therapeutic goals should not be focused on treatment but also on waist circumference reduction in order to reduce inflammation and improve patients’ functional ability and quality of life.

PP36 Early Diagnosis And Treatment Of Psoriatic Arthritis

Introduction:Screening for psoriatic arthritis (PsA) is expected to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. This study estimated the cost-effectiveness of screening tools for PsA in Canada.Methods:A Markov model was built to estimate the associated costs and quality-adjusted life-years (QALYs) of screening tools for PsA in patients using topical treatment for psoriasis. The screening tools included: the Toronto Psoriatic Arthritis Screening (ToPAS) questionnaire; the Psoriasis Epidemiology Screening Tool (PEST); the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire; and the Early ARthritis for Psoriatic patients (EARP) questionnaire. Health states were defined by disability levels, as measured by the Health Assessment Questionnaire (HAQ), and state transition was modeled according to annual disease progression. Screening was assumed to be effective during a 2-year sojourn period. Incremental cost-effectiveness ratios (ICERs) were estimated based on health-state specific costs and utilities. A probabilistic analysis was undertaken to account for parameter uncertainty. All results were compared with the commonly cited cost-effectiveness threshold of CAD 50,000 (USD 37, 600) per additional QALY.Results:Screening with the ToPAS questionnaire resulted in cost savings compared with no screening or the EARP questionnaire, with a total cost of CAD 30,706 (USD 23,090) and 17.29 QALYs. The PEST dominated the PASE questionnaire and was more costly and more effective than the ToPAS questionnaire, with an ICER of CAD 312,398 (USD 234,909). The results were most sensitive to test sensitivity and specificity, HAQ progression, and average HAQ score at diagnosis and the start of biologic therapy. A scenario analysis tested screening efficacy for a 1-year period before diagnosis, with the ToPAS questionnaire remaining the most cost-effective option.Conclusions:Screening was cost-effective compared with no screening at the commonly used cost-effectiveness threshold of CAD 50,000 (USD 37, 600). Value of information analyses will be useful for determining the need to collect further information around test accuracy parameters.

Nutrition and quality of life referring to physical abilities - a comparative analysis of a questionnaire study of patients with rheumatoid arthritis and osteoarthritis.

ObjectivesA comparative analysis of opinions on diet and nutrition of patients suffering from rheumatoid arthritis (RA) and osteoarthritis (OA), and quality of life limited to physical abilities in both study groups.Material and methodsIn the period from August to December 2012 an anonymous questionnaire survey was carried out among the patients of the Institute of Rheumatology. The respondents were asked to define their dietary preferences, dietary supplementation, and the level of physical limitations by completing the Health Assessment Questionnaire (HAQ). The study was carried out with the consent of the Bioethics Committee.ResultsA total of 397 questionnaires were obtained. The majority of respondents were women (77%). 62% of RA patients (165 respondents) had been treated for over 10 years as opposed to OA patients (80 respondents), where the largest group (33%) were patients during their first year. There is a significant difference in the disability level of patients in both compared groups. The average HAQ of RA patients was 1.09 and OA patients – 0.46. A change of dietary habits was declared by 32% of RA patients and by 17% of OA patients (p = 0.049) mostly without consulting a specialist – it concerned mainly limiting the consumption of sweets (30% vs. 21%), a meatless diet: 19% vs. 14%, and a non-dairy diet: 9% vs. 14%.ConclusionsRegardless of their diagnosis, the respondents believe that the way of eating affects their health. There are visible differences between diet and dietary supplementation, depending on the diagnosis of the disease. Differences were also observed in physical limitations of both patient groups – a higher level of disability was noted among RA patients. It is necessary to continue the topic at the level of clinical trials and medical experiments within the scope of the impact of diet as a supportive element in the treatment of rheumatic diseases.

Parity influences the severity of ACPA-negative early rheumatoid arthritis: a cohort study based on the Swedish EIRA material.

BackgroundIn women with rheumatoid arthritis (RA) it has been observed that during pregnancy a majority of patients experience amelioration, but after delivery a relapse of the disease is common. However, there are few studies, with diverging results, addressing the effect of parity on the severity of RA over time. Our aim was to explore the impact of parity, with stratification for anti-citrullinated protein antibody (ACPA) status as well as for onset during reproductive age or not.MethodsFemale RA cases aged 18–70 years were recruited for the Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Information on disease severity (the health assessment questionnaire (HAQ) and the disease activity score 28 (DAS28)) was retrieved from the Swedish Rheumatology Quality Register at inclusion and 3, 6, 12 and 24 months after diagnosis. Mixed models were used to compare mean DAS28 and HAQ scores over time in parous and nulliparous women. Mean differences at individual follow-up visits were compared using analysis of covariance. The odds of having DAS28 or HAQ above the median in parous verus nulliparous women were estimated in logistic regression models.ResultsA total of 1237 female cases (mean age 51 years, 65 % ACPA-positive) were included. ACPA-negative parous women, aged 18–44 years, had on average 1.17 units higher DAS28 (p < 0.001) and 0.43 units higher HAQ score (p < 0.001) compared to nulliparous women during the follow-up time, adjusted for age. In this subgroup, the average DAS28 and HAQ scores were significantly higher in parous women at all follow-up time points. Younger parous ACPA-negative women were significantly more likely to have DAS28 and HAQ values above the median compared to nulliparous women at all follow-up visits. No association between parity and severity of ACPA-positive disease was observed.ConclusionsParity was a predictor of a more severe RA among ACPA-negative younger women, which might indicate that immunomodulatory changes during and after pregnancy affect RA severity, in particular for the ACPA-negative RA phenotype.

HAM-net national patient registration system reveals details of how Japanese patients with HTLV-1-associated myelopathy/tropical spastic paraparesis progress over time

In order to better understand and manage HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), a rare virus-induced neurodegenerative disease, we have established a registration system known as HAM-net to gather data from patients all over Japan. In this prospective epidemiological study, we analyzed the data from the 297 registered patients who were available to be interviewed once upon registration and again one year later. On average, these patients were 63.2 years old, had experienced their first symptoms at age 44.2, and were diagnosed at age 51.3. More patients were female (74.1%) than male (25.9%). During the one-year interval between surveys, the average Health Assessment Questionnaire Disability Index (HAQ-DI) score rose significantly (P<0.001), indicating noticeably declining health. The average Osame Motor Disability Score (OMDS) also worsened (P<0.001), rising from 5.9±2.3 to 6.2±2.4. While the majority of patients (81%) experienced no change in OMDS, 53 patients (18%) worsened, and only 4 patients (1%) improved. Importantly, when compared to patients given other treatments, those treated continuously with oral steroids were less likely to experience a rise in OMDS. Fifty-four of the patients were deemed “rapid progressors,” defined as a patient who progressed from the onset of motor symptoms to at least OMDS 5 within two years, and 15 of those were “very rapid progressors,” defined as those who reached at least OMDS 6. Both rapid progressors and very rapid progressors exhibited several statistically significant traits compared to the other patients: older when motor symptoms first manifested, older when first diagnosed, higher OMDS, higher HAQ-DI score, shorter gap between disease onset and diagnosis, and shorter disease duration from onset to present day. We will continue registering new patients and analyzing changes in their health over time.

Walking Disability Raises Risk of CVD, Diabetes Problems

Walking Disability Raises Risk of CVD, Diabetes Problems

THU0260 Delay in RA Diagnosis of More than 12 Months is Associated with Deteriorated Functional Status in Patients in Bdmard Treatment– Results from A Prospective Study

BackgroundThe nationwide DANBIO registry includes data on patients with rheumatoid arthritis (RA) and their treatment with biological disease modifying anti-rheumatic drugs (bDMARD), functional status as well as time for onset...

FRI0076 The effects of tight disease control of rheumatoid arthritis on HAQ

BackgroundTreat to Target (T2T) is the main strategy for the treatment of rheumatoid arthritis (RA). We need to control disease activity in order to sustain ADL in optimal status and...

Influence of balneophysical therapy on activity, functional capacity, and quality of life in patients with rheumatoid arthritis

It has been well known that balneophysical therapy has a therapeutic effect on clinical and biological parameters of disease activity in the patients with rheumatoid arthritis (RA). To determine the influence of balneophysical therapy on functional capacity, activity and quality of life of the patients with RA primarily treated with some of disease modifying antirheumatic drugs. The study enrolled 73 patients with RA treated with some of disease modifying antirheumatic drugs (Methotrexate in 85% of patients). During hospitalization at the Clinical Rheumatologic Department of the Institute "Niska Banja", the patients were treated, beside the medicamentous therapy, by hydrotherapy (oligomineral, homeothermic, low radioactive water), mineral peloid therapy, electrotherapy and kinesiotherapy. Before and after balneotherapy, the patients filled in the Health Assessment Questionnaire (HAQ) and the Quality of Life Rheumatoid Arthritis (QOL-RA) scale. The Disease Activity Score (DAS) 28 was used to measure the disease activity before and after balneotherapy. A possible value of HAQ was from 0 to 3, and QOL-RA from 0 to 10. The mean value of the duration of balneophysical therapy was 14.7 +/- 4.8 days. We found significant improvement of functional capacity in the patients with RA. The average HAQ score before balneotherapy was 1.07 +/- 0.61, and 0.86 +/- 0.55 after balneotherapy, which was statistically significantly lower (p < 0.05). DAS 28 after balneotherapy was also statistically significantly lower than DAS 28 before balneotherapy: the mean value of DAS 28 before therapy was 6.30 +/- 0.81 and after therapy 5.48 +/- 0.75 (p < 0.001). The quality of life significantly improved after balneophysical therapy: the mean value of QOL-RA scale before therapy was 5.38 +/- 1.62 and after therapy 7.35 +/- 1.81 (p < 0.05). Balneophysical therapy, when properly dosed, is an effective, adjuvant therapy in the patients with RA of mild disease activity. Balneophysical therapy has a positive influence on disease activity, functional capacity and quality of life in the patients with rheumatoid arthritis.

Nivel de conocimiento de los pacientes con artritis reumatoide acerca de su enfermedad y tratamiento

The transfer of information in the physician-patient relationship is important, especially in chronic diseases such as Rheumatoid Arthritis (RA), since it influences the perception and behavior that the patient has about his or her illness. To evaluate the level of knowledge and concern of their illness and treatment and their relationship with functional disability, perception of the pain and global assessment of disease activity, in patients with RA. Cross sectional study of 104 patients (mean age 56 years, 100 women) with RA. Demographic and clinical variables were registered. The knowledge about their illness and requirement of further information and concern about aspects of the illness and treatment, were assessed. Physical functioning was measured using the Health Assessment Questionnaire (HAQ). A visual analogue (VAS) and Likert scales were used for a global assessment of disease activity. Sixty percent of patients had only primary school studies. The median evolution of the illness was 14 years. Ninety eight percent knew their diagnosis and 91% required further information. There was a high degree of concern about the disease and treatment. The average HAQ score was 0.9. There was a statistically significant relationship between HAQ score and pain VAS (r =0.41, p <0.01). There was a moderate agreement between the global assessment of disease activity made by patients and physicians (Kappa =0.499; p =0.000). Even though patients with RA are informed about their disease, they require further information. Their highest concern is about the functional consequences of RA and they perceive a higher activity of the disease than their treating physicians.

Measuring function in rheumatoid arthritis: Identifying reversible and irreversible components

Measurement of physical function at one point in time cannot distinguish impairment caused by the active disease process from chronic irreversible impairment. We aimed to dissect these two components of functional limitation in rheumatoid arthritis (RA) by using the disability index of the Health Assessment Questionnaire (HAQ) as the measure of function. We performed a secondary analysis of data from 6 contemporary clinical trials of RA (2,763 patients). Patients in whom remission was achieved in the trials, based on a simplified disease activity index, were identified. In an individual patient, HAQ scores at trial entry represented both reversible and irreversible impairments, while HAQ scores at the time of RA remission represented the mostly irreversible component, and the difference between these corresponded to the component related to disease activity. We tested the concept that the HAQ has a reversible and an irreversible component by associating the HAQ score during remission with 2 measures associated with the degree of accrued damage: duration of RA and radiographic severity. Among patients in whom clinical remission was achieved (n = 295), average HAQ scores despite clinical remission increased progressively with the duration of RA, from 0.19 (<2 years of RA) to 0.36 (2-<5 years) to 0.38 (5-<10 years) to 0.55 (>/=10 years) (P < 0.001). The reversibility of HAQ scores decreased with the duration of RA (median 100%, 83.3%, 81.9%, and 66.7%, respectively; P < 0.001). Findings were similar in patients subgrouped by quartile of radiographic scores. Differences in the sources of functional limitations should be considered in the interpretation of functional measures, and in their use for prediction and in cost analyses.