Disability In Rheumatoid Arthritis Research Articles

How do symptoms of each joint contribute to global pain, disease activity and functional disability in rheumatoid arthritis?-A comprehensive association study using a large cohort.

Established assessment tools for patients with rheumatoid arthritis (RA), including disease activity scores (DASs), disease activity indexes (DAIs), visual analog scales (VASs), and health assessment questionnaires (HAQs), are widely used. However, comparative associations between joint involvement and disease status assessment tools have rarely been investigated. We included a dataset of 4016 patients from a large RA cohort from 2012 to 2019. The tenderness and swelling of each joint were counted as a symptom, with 70 and 68 affected joints throughout the body, respectively. The relative contribution of various joints to the disease status assessment tools, VAS scores, and functional disability indexes was analyzed using multiple regression analysis. The wrist showed the most significant contribution overall, especially in DASs and VASs, while the metacarpophalangeal and proximal interphalangeal joints made significant contributions to DASs and DAIs, but not to VASs and HAQs. The shoulder and the elbow significantly contributed to HAQs, but only the shoulder did to the VASs. The knee universally contributed to all of the tools, but the ankle played a minor but important role in most assessment tools, especially in HAQs. Similar but different contribution ratios were found between the sets of DASs, DAIs, VASs, or HAQs. Each joint makes a unique contribution to these assessment tools. The improvement or aggravation of symptoms in each joint affects the assessment tools in different manners.

Estimation of the global prevalence, incidence, years lived with disability of rheumatoid arthritis in 2019 and forecasted incidence in 2040: results from the Global Burden of Disease Study 2019.

We aimed to provide a better understanding of the secular trends in rheumatoid arthritis (RA) burden at the regional and national levels, contributing to identifying the areas with high burden needs and finding the potential areas requiring additional attention, which will facilitate the development of strategies tailored to RA burden. Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 study. We presented the secular trends in the prevalence, incidence, and years lived with disability (YLDs) of RA needs by sex, age, sociodemographic index (SDI), region, country, and category between 1990 and 2019 using data from the GBD 2019 study. The age-standardized rates (ASR) and its estimated annual percentage changes (EAPCs) are employed to describe the secular trends in RA. Globally, there were an estimated 18.5 million [95% confidence interval (CI) 31.53 to 41.74)] prevalent cases of RA, with 1.07 million (95% CI 0.95 to 1.18) incident cases per year and almost 2.43 million YLDs (95% CI 1.68 to 3.28) in 2019. The age-standardized prevalence and incidence rates estimated for RA were 224.25 per 100,000 and 12.21 per 100,000 in 2019, with EAPCs of 0.37 (95% CI - 0.32, 0.42) and 0.30 (95% CI 0.25 to 0.34), respectively. The corresponding age-standardized YLDs estimated was 29.35 per 100,000 in 2019, with an EAPC of 0.38 (95% CI: 0.33, 0.43). During the study period, the ASR of RA was consistently higher in females than in males. Moreover, the age-standardized YLD rate of RA was associated with the sociodemographic index (SDI) in 2019 across all 204 countries and territories (R = 0.28). The projections indicate that the age-standardized incidence rates (ASIR) trend will continue to increase from 2019 to 2040, with a projected ASIR of 10.48 and 4.63/100,000 for females and males, respectively. RA is prevalent and remains a significant global public health challenge. Globally, the burden of RA has increased over the past 30years and will continue to increase. Prevention and early treatment of RA are pivotal to avoiding disease onset and alleviating the enormous burden. Key Points • The burden of rheumatoid arthritis is increasing globally. • Global estimates indicate that the number of RA incident cases will increase 1.4-fold globally, from approximately 1.07 million at the end of 2019 to approximately 1.5 million by 2040.

Influence of Social Support, Financial Status, and Lifestyle on the Disparity Between Inflammation and Disability in Rheumatoid Arthritis.

To investigate how social support, financial status, and lifestyle influence the development of excess disability in rheumatoid arthritis (RA). Data were obtained from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having "excess disability." Self-reported data regarding contextual factors (social support, financial situation, lifestyle) were obtained from participants, and they completed patient-reported outcome measures (pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by patient-reported outcome measures were assessed using structural equation models. Findings were validated in 2 independent data sets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]). Of 538 included ESPOIR participants (mean age ± SD 48.3 ± 12.2 years; 79.2% women), 200 participants (37.2%) were in the excess disability group. Less social support (β=0.17 [95% confidence interval (95% CI) 0.08, 0.26]), worse financial situation (β=0.24 [95% CI 0.14, 0.34]), less exercise (β=0.17 [95% CI 0.09-0.25]), and less education (β = 0.15 [95% CI 0.06, 0.23]) were associated with excess disability group membership; smoking, alcohol consumption, and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN. Greater emphasis is needed on the economic and social contexts of individuals with RA at presentation; these factors might influence disability over the following decade.

Gender-Based Frequency and Associated Disability of Rheumatoid Arthritis: A Cross-Sectional Study

Objective: To determine the frequency and associated disability of rheumatoid arthritis in male and female patients Methodology: This was a cross sectional survey conducted at the National Institute of Rehabilitation Science, Pakistan Institute of Medical Science and Pakistan Railways Hospital for one year from February 2019 to February 2020. Study includes diagnosed cases of both genders with ages between 30 to 60 years and fulfilling the 1987 American College of Rheumatology (ACR) criteria. Patients with disabilities due to other reasons were excluded. Sample size of the study was calculated to be 143 using Epi-tool. Sampling technique was non-probability purposive sampling technique. For this study WHODAS-2.0 screening tool was used. Results: Out of 143 patients, 52 (36.4%) were males and 91(63.6%) were females. The mean age of both males and females was 43.41 ± 8.605 SD. We found that 18 (34.6%) male patients presented with mild disability. While in females, 54 (59.3%), 32 (35.16%), 5 (5.49%), and 0 (0%) patients out of 91, reported with mild, moderate, severe, and extreme disabilities respectively. Conclusion: RA is more prevalent in females than in males with the majority of the patients reporting mild disability and more female patients disabled than men.

Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis

Objective To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis. Method Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010–2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward’s method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0–100), and total annual health service-related direct costs (€) as clustering variables. Results Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities. Conclusions The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.

Anti-Carbamylated antibodies as a marker of activity and disability in Rheumatoid Arthritis

Anti-Carbamylated antibodies as a marker of activity and disability in Rheumatoid Arthritis

Estimation of the Global Prevalence, Incidence, Years Lived with Disability of Rheumatoid Arthritis in 2019 and Forecasted Incidence in 2040: Results From The Global Burden Of Disease Study 2019

Estimation of the Global Prevalence, Incidence, Years Lived with Disability of Rheumatoid Arthritis in 2019 and Forecasted Incidence in 2040: Results From The Global Burden Of Disease Study 2019

Engineered glove to evaluate hand disability in rheumatoid arthritis: A pilot-study.

The Hand Test System (HTS) is an engineered-sensorized glove that has been originally developed in the neuroscientific field for the evaluation of hand fingers' speed movement. This pilot-study aimed to evaluate the reproducibility of HTS analysis in rheumatoid arthritis (RA), correlating glove-derived parameters with clinical disease activity indexes, self-reported disability-related questionnaires and hand strength. Fifty-five RA patients and fifty age and sex matched healthy controls (HCs) performed HTS analysis. The glove recognized the touch speed between the finger tips during standard sequences of movements, providing three quantitative parameters: touch duration (TD), inter-tapping interval (ITI) and movement rate (MR). These variables were correlated with Health Assessment Questionnaire (HAQ), Health Assessment Questionnaire-Disease Index (HAQ-DI), Hand Disability Index (HDI), Hand Grip Strength (HGS), DAS28-CRP, CDAI and SDAI. Intraclass correlation coefficient was 0.93 (CI: 0.92, 0.95). RA patients showed significantly slower TD, ITI and MR than HCs, for all classes of disease activity (P<0.001). All HTS parameters correlated significantly with HAQ, HAQ-DI, HDI, HGS, DAS28-CRP, SDAI, CDAI (between P<0.05 and P<0.001). Of note, also RA patients in clinical remission showed a significantly higher TD compared with HCs (P<0.001). HTS seems a new safe and fast tool to evaluate rheumatoid hand's functionality, measuring the speed of finger movements. Furthermore, the HTS parameters significantly correlate with quality of life, disease activity, hand strength and perceived hand disability, evaluating also potential hand motor impairment in RA clinical remission.

Rheumatoid Arthritis Disability and Absence Trends in the United States

Objectives: Employers increasingly focus on absence benefits and connections with employee health. United States absence benefits include Sick Leave (SL), Short- and Long-Term Disability (STD and LTD, respectively) for non-work-related injuries/illnesses, and Workers’ Compensation (WC) for work-related injuries/illnesses. This research explores all-cause absence (SL, STD, LTD, and WC) utilization and changes from baseline for eligible employees with rheumatoid arthritis to determine if the use a constant payment factor is appropriate for models. Study Design: Retrospective multi-year database analysis. Methods: The Workpartners database (1/1/2001-12/31/2019) was used to identify employees with rheumatoid arthritis with adjudicated medical claims. Annual prevalence, benefit utilization, mean days of leave, and median payments (as % of salary) were analyzed. Annual outcomes were calculated as a percent of baseline (2001). Results: Rheumatoid arthritis prevalence averaged 0.5% between 2001 and 2019. At baseline, the percent of eligible employees using STD = 15.5%, LTD = 0.7%, WC = 1.7%, SL = 61.7%. Mean absence days were 48.5, 367.5, 43.8 for STD, LTD, WC, respectively and median payments were 70.5%, 22.2%, 65.7% of salary for STD, LTD, WC, respectively. From 2002-2019: 11.7%-16.9% of eligible employees filed STD claims for 82.1%-995.9% of baseline days and 80.4%-125.9% median payments; 0.6%-2.9% of eligible employees filed LTD claims for 66.6%-114.7% of baseline days and 63.2%-254.8% median payments; 0.3%-1.6% of eligible employees filed WC claims for 44.0%-472.8% of baseline days and 70.4%-271.5% median payments. Median payments were highest in 2012, 2019, 2003 for STD, LTD, WC, respectively and the most absence days were used in 2017 for SL and LTD, 2008 for STD, and 2005 WC. Conclusion: Employees with rheumatoid arthritis used absence benefits at differing rates over time with varying leave-lengths and payments. Using a constant cost or salary replacement factor for absence costs over time and across benefits is not accurate.

Understanding Fatigue-Related Disability in Rheumatoid Arthritis and Ankylosing Spondylitis: The Importance of Daily Correlates.

Fatigue is common among people with inflammatory arthritis but is hard to manage. The aim of this study was to investigate how daily fluctuations in psychological variables correspond with changes in fatigue-related disability in the daily lives of people with inflammatory arthritis and to identify factors to target in psychological interventions and routine clinical practice. A cohort of 143 patients with rheumatoid arthritis (n = 97) or ankylosing spondylitis (n = 46) participated in a 10-day online diary study. Each evening participants completed a diary questionnaire assessing their fatigue, pain, fatigue-related disability, and 4 components of psychological flexibility (valued activity, mindfulness, cognitive fusion, and fatigue avoidance). On days when participants were more engaged in valued activities or more mindful, they reported less disability due to fatigue, even when controlling for levels of fatigue and pain that day. The daily psychological flexibility variables explained a total of 15.6% of the variance in daily fatigue-related disability. Psychological flexibility variables are directly associated with fatigue-related disability in the daily lives of inflammatory arthritis patients. Further research is needed to investigate whether interventions that target psychological flexibility are effective at reducing fatigue-related disability.

Association of body composition with disease activity and disability in rheumatoid arthritis

Background/AimsTo explore the associations between body composition and pain, disease activity, and disability in rheumatoid arthritis (RA).MethodsThe study enrolled 335 patients with RA and underwent body composition measurement with an InBody analyzer. The associations of body mass index (BMI), body fat mass, and skeletal muscle mass with disease activity score in 28 joints (DAS28), an index derived to measure the subjective component of DAS28 (DAS28-P), a pain visual analogue scale (VAS), and disability measured with the health assessment questionnaire (HAQ) were explored. Obesity was defined as BMI ≥ 25 kg/m2.ResultsThe median (interquartile range) disease duration was 6 years (3.5 to 9) and the mean DAS28 score was 3.6 ± 1.1. The mean BMI was 23.6 ± 3.6 kg/m2 and 109 patients (32.5%) were obese. Compared with non-obese patients, obese patients had a higher C-reactive protein (1.68 mg/dL vs. < 0.1 mg/dL, p = 0.013), higher pain VAS score (40 vs. 35, p = 0.031), and higher DAS28-erythrocyte sedimentation rate score (3.75 ± 1.18 vs. 3.46 ± 1.11, p = 0.031). In multivariate regression analysis, the DAS28 score in females was positively associated with the current steroid dose, body fat mass, and HAQ score, while the HAQ score in females was associated with older age, DAS28, lower skeletal muscle mass, and higher body fat/skeletal muscle ratio. In the multivariate regression analysis, the DAS28-P score in females was positively associated with body fat/skeletal muscle ratio and HAQ.ConclusionsBody composition, such as the body fat mass and body fat/skeletal muscle ratio, is significantly associated with disease activity and disability in female RA patients.

Imperative and effective reversion of synovial hyperplasia and cartilage destruction in rheumatoid arthritis through multiple synergistic effects of O2 and Ca2.

Abnormal synovial hyperplasia and cartilage destruction in a joint cavity are the key causes affecting the pain and disability in rheumatoid arthritis (RA) and, unfortunately, there exists no effective treatment for them. This investigation reports an effective reversion of the above pathological characteristics in RA owing to the use of a prolonged O2/Ca2+-supporting phototherapy hydrogel. The performed in vitro and in vivo experiments exhibit that the prolonged O2-supporting not only promotes the direct cell-killing effects of singlet oxygen, but also persistently blocks the pathological feedback between the abnormal proliferation of fibroblast-like synoviocyte and the local oxygen depletion. Furthermore, the Ca2+, which is the other decomposition product of the O2 donor, induces mitochondrial Ca2+ overload and endoplasmic reticulum Ca2+ disorder and triggers Ca2+-associated apoptosis and immunogenic cell death. In addition to these multiple synergistic effects on synovial hyperplasia, the prolonged Ca2+ support can also induce the regeneration of cartilage in RA affected joints. The present study may thus provide an effective therapeutic strategy for the prevention and reversion of joint lesions and the accompanying arthralgia and deformity in RA.

Skeletal muscle disease in rheumatoid arthritis: the center of cardiometabolic comorbidities?

Despite its critical roles in body movement, structure, and metabolism, skeletal muscle remains underappreciated in the context of rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation, physical inactivity, and medication toxicities impair skeletal muscle. These skeletal muscle alterations contribute to continued rheumatoid arthritis disparities in physical function and cardiometabolic health. In the prebiologic disease-modifying antirheumatic drug era, rheumatoid arthritis skeletal muscle atrophy was the central feature of 'rheumatoid cachexia,' a hypermetabolic state driven by chronic systemic inflammation and muscle protein degradation. In the current era, rheumatoid arthritis muscle deficits are less visible, yet persist as a key component of 'sarcopenic obesity.' In rheumatoid arthritis sarcopenic obesity, chronic inflammation, physical inactivity, and medication toxicities contribute to muscle contractile deficits, inflammation, altered metabolism, and intramuscular adiposity, a key predictor of rheumatoid arthritis disability and insulin resistance. Rheumatoid arthritis skeletal muscle disease in the current era is defined by impaired contractile function (poor strength and endurance) and sarcopenic obesity (decreased muscle mass, increased fat mass, and intramuscular adiposity). These muscle impairments contribute to disability and cardiometabolic disease in rheumatoid arthritis. Management should focus on monitoring of rheumatoid arthritis muscle function and body composition, limiting potentially myotoxic drugs, and prescription of exercise training.

Anti-Carbamylated antibodies as a marker of activity and disability in Rheumatoid Arthritis

Anti-Carbamylated antibodies as a marker of activity and disability in Rheumatoid Arthritis

Validation and assessment of minimally clinically important difference of the unadjusted Health Assessment Questionnaire in a Danish cohort: uncovering ordinal bias

Objectives: The Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) is a widely used patient-reported outcome for functional disability in rheumatoid arthritis (RA). Minimal clinically important differences (MCIDs) in the HAQ-DI were previously calculated based on device-corrected ordinal HAQ-DI scores, leading to limited generalizability and validity for today’s patients. Our objectives were to examine the internal construct validity of the unadjusted HAQ-DI and to determine an MCID in a cohort of Danish RA patients based on the transformed linear logit scale of the HAQ-DI.Method: The study included 362 RA patients registered in the DANBIO registry. The Rasch model was fitted to HAQ-DI data at baseline and after 3 months’ follow-up. MCID was calculated as the median changes in the original HAQ-DI score and logit HAQ-DI score in those patients who had experienced minimal improvement (15–30 mm on a 0–100 mm Patient Global scale).Results: HAQ-DI data showed acceptable fit to the Rasch model at both time-points, and consistent item ranking across time indicated instrument invariance. Sixty-one patients (16.8%, ~1/6) had an improvement above the MCID on the logit scale but improvement below the MCID on the original scale, while the opposite was not the case for any patients.Conclusions: The Danish unadjusted version of the HAQ-DI showed acceptable internal construct validity. Application of the logit MCID classified an additional one in six patients as having achieved an MCID compared to the MCID calculated on the ordinal scale, which may have potential implications for the powering of future studies.

Trends in Prevalence of Functional Disability in Rheumatoid Arthritis Compared With the General Population

The objective of the study was to assess trends in functional disability (FD) in patients with rheumatoid arthritis (RA) vs individuals without RA. This retrospective population-based study included 586 patients with RA and 531 individuals without RA. Information on activities of daily living was obtained from self-report questionnaires. The prevalence of FD was higher in those with RA (586 [26%]) vs those without RA (531 [11%]) at RA incidence/index date (P<.001), with persistent excess over the follow-up and calendar time. Patients with RA had a 15% or higher prevalence of FD than individuals without RA in most age groups. Patients with RA have a higher prevalence of FD across RA duration, age, and calendar time than those without RA.

Effects of forefoot arthroplasty on plantar pressure, pain, gait and disability in rheumatoid arthritis

Objectives: The purpose of this study was to clarify the effect of forefoot arthroplasty on plantar pressure, pain, gait, and disability within 1 year after arthroplasty in patients with RA.Methods: Eleven patients with RA who underwent forefoot arthroplasty completed this quasi-experimental study. Outcome measures were in-shoe plantar pressure, visual analog scale (VAS) for pain, temporal gait parameters, and modified Health Assessment Questionnaire (mHAQ), obtained preoperatively and at 4 and 12 months postoperatively.Results: The average peak plantar pressure under the 2nd metatarsal head decreased at 4 months postoperatively, compared to preoperative values (p < .05) and the decreased plantar pressure was sustained at 12 months postoperatively. Similar changes were observed under the 3rd to 5th metatarsal heads. The median VAS for foot pain decreased from 25 mm preoperatively to 1 mm at 4 months postoperatively and the lower score was sustained at 12 months postoperatively (p < .05). The median mHAQ score remained lower (<1.0) at all measurement points. Regarding gait, there were no significant differences from the preoperative assessment to postoperative follow-up.Conclusion: Plantar pressure and forefoot pain decreased at 4 and 12 months after forefoot arthroplasty in patients with RA. No adverse effects on gait parameters or disability were observed.

Rheumatoid factor as predictor of response to treatment with anti-TNF alpha drugs in patients with rheumatoid arthritis

We determined whether rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) can predict remission or severe disability in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor (TNF) alpha drugs.We performed a cohort study based on the clinical data from a referral center for the treatment of RA in Bogotá, Colombia, were included patients aged ≥18 years with diagnosis of RA with an active disease and for whom a treatment scheme was begun with anti-TNF alpha medication, with a minimum follow-up time of 12 months. Disease activity of Rheumatoid Arthritis was assessed through measurement of RF, ACPA, disease activity score (DAS28), and health assessment questionnaire (HAQ). We calculated the incidence rates (IRs) for remission and severe disability. We also calculated the incidence rate ratio (IRR) for each outcome by adjusting for possible confounders using the Poisson regression method. The hypothesis was tested with a P value of <.05. Statistical analysis was performed in Stata 15.We included 400 patients receiving an anti-TNF alpha agent. Median age was 60 years, and 322 patients were women (80.5%). RF was positive in 357 patients (89%), ACPA in 348 patients (87%), and co-positivity in 324 patients (81%). Median follow-up was 41 months (range, 12–79 months). The IR for remission was 23 per 100 person-years in RF-negative patients and 16 per 100 person-years in RF-positive patients. The adjusted IRR (age sex, treatment, and ACPA) was 1.51 (95%CI, 1.05–2.18). The IR for severe disability was 10.8 per 100 person-years in the RF-positive cohort and 2.3 per 100 person-years in the RF-negative cohort. The IRR adjusted for these factors was 4.37 (95%CI, 1.6–12). Co-positivity had a similar behavior to RF. No differences were recorded in the rates of remission or disability in ACPA-positive and ACPA-negative patients.Our findings suggest that remission is less frequent and severe disability more frequent in RF-positive patients treated with anti-TNF alpha agents than in RF-negative patients.

Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis.

Objective of this study is to evaluate the construct validity and the interpretability of the shortened Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) in the assessment of rheumatoid arthritis (RA) hand disability. Consecutive RA patients were assessed through the QuickDASH and other function and disease activity indices, respectively, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Recent-Onset Arthritis Disability questionnaire (ROAD). For each patient were evaluated the tender and swollen 28-joints counts. Interpretability was defined determining cut-off points of impairment in accordance to the Simplified Disease Activity Index (SDAI) definition of disease activity states. A total of 440 patients (89 men and 351 women, mean age of 57.0 ± 12.7years) were enrolled. Following the SDAI definition, 98 patients (22.3%) resulted in REM, 115 subjects (26.1%) in LDA, 74 patients (16.8%) in MDA, and 153 subjects (34.8%) in HDA. Mean QuickDASH differed significantly between patients classified as remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) (p < 0.001). High correlations were found comparing QuickDASH to composite indices of disease activity and of physical health function: of special interest are the correlations between the comparable dimension of the QuickDASH and the ROAD Upper Extremity Function (rho = 0.876; p < 0.001). The cut-off points for functional categories (SDAI categories as external criterion) resulted: no impairment ≤ 13, 13 < low impairment ≤ 18.5, 18.5 < moderate impairment ≤ 31.5, and high impairment > 31.5. QuickDASH is useful in clinical practice, for its ease of administration, and positively correlates with the disease activity. It may be a surrogate for evaluating upper extremity impairment, disability index and disease control in RA patients.

Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis.

Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. This study included patients with RA from the National Data Bank for Rheumatic Diseases (FORWARD) (n = 23,323) and the Veterans Affairs RA (VARA) registry study (n = 1,697). Results of the Health Assessment Questionnaire (HAQ) or Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). In multivariable models, patients who were severely obese at enrollment had a greater risk of progressive disability compared to overweight patients in FORWARD (HR 1.25 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.