Version Of Health Assessment Questionnaire Research Articles

Psoriatic Arthritis Quality of Life questionnaire: Translation, cultural adaptation and validation into Arabic language.

Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that has a strong negative impact on the quality of life (QoL) of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire was the first disease-specific patient-derived instrument developed to measure the QoL in patients with PsA. Our objective was to translate the PsAQol into Arabic language and evaluate its reliability and validity in patients with PsA. This was a cross-sectional study including patients with PsA. A clinical and biological assessment of the patients was performed at inclusion. The translation of the original PsAQoL into Arabic was performed by a professional bilingual and lay panel. Eight patients were interviewed to assess face and content validity. A separate sample of PsA patients (n=30) were invited to participate in a test-retest postal study in order to investigate reproducibility and construct validity. One week separated the two administrations. The Arabic version of Health Assessment Questionnaire (HAQ) was used as a comparator instrument for convergent validity. Face and content validity were satisfactory. The Arabic version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. One item was excluded (item 16). It had no correlation with either the other 19 items or the total score of PsAQol. The Arabic PsAQol had excellent internal consistency (Cronbach's a=0.926), and test-retest reliability (r=0.982). There was a positive correlation between the total score of the PsAQoL and the Arabic version of HAQ (Spearman's r=0.838, p<10-3 ). Exploratory factor analysis had extracted two factors explaining 55% of the total variance. Nineteen items were selected to compose the Arabic version of PsAQoL, which was found to be relevant and understandable and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine care for patients' assessment.

Reliability and Validity of the Korean Version of the Gout Impact Scale.

The Gout Impact Scale (GIS), part of the Gout Assessment Questionnaire 2.0, measures gout-specific health-related quality of life (HRQOL). This study aimed to translate the GIS into Korean and validate the Korean version (K-GIS) using generic HRQOL measures. The GIS was translated into Korean and back-translated into English. We asked patients aged 18 years or older who met the 2015 gout classification criteria to fill out the questionnaires (from January 2022 to June 2022); the K-GIS (5 scales [0-100 scores each]), along with the Korean version of Health Assessment Questionnaire (HAQ) and EuroQol-5 dimension (EQ-5D). We investigated the internal consistency, construct validity, and discriminative validity for gout characteristics of K-GIS. The K-GIS form was administrated to patients 4 weeks later to assess the test-retest reliability using the intraclass correlation coefficient (ICC). One hundred patients completed the questionnaire. The mean ± standard deviation age of the patients was 53.0 ± 15.1 years, and 99.0% of the patients were men. All scales had high degree of internal consistency (Cronbach's α = 0.59 to 0.96) and test-retest reliability (n = 18, ICC = 0.83 to 0.94, all P < 0.001), except for unmet gout treatment needs. Weak-to-moderate correlations were observed between the K-GIS scales and HAQ or EQ-5D (r = 0.21 to 0.46). The K-GIS scores were significantly higher in the presence of bone erosion, absence of urate-lowering therapy, serum urate levels > 6 mg/dL, frequent gout flares in the past year, and fewer comorbidities. In contrast, neither the HAQ nor the EQ-5D could discern these subsets of patients. The K-GIS is a reliable and valid HRQOL measure for patients with gout. Higher K-GIS scores were associated with clinical characteristics leading to unfavorable outcomes, which were not demonstrated by the HAQ and EQ-5D.

Cost-consequence of abatacept as first-line therapy in Japanese rheumatoid arthritis patients using IORRA real-world data.

To investigate the cost-effectiveness of abatacept (ABA) as first-line (1L) therapy in Japanese rheumatoid arthritis (RA) patients using data from the Institute of Rheumatology, Rheumatoid Arthritis database. A decision-analytic model was used to estimate the cost per American College of Rheumatology response of at least 50% improvement (ACR50) responder and per patient in Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) remission from a Japanese healthcare payers' perspective over a 2-year time horizon. Clinical characteristics of patients on ABA-1L were matched with those of patients on ABA second or later line (2L+) or tumour necrosis factor inhibitor (TNFi)-1L directly or using propensity scores. Resource utilisation and medical costs were calculated from the Japan Medical Data Center claims database. Parameter uncertainty was addressed by sensitivity and subgroup analyses (age, treatment duration, Japanese version of Health Assessment Questionnaire [J-HAQ] score). Incremental costs per member per month (ΔPMPM) for ABA-1L versus TNFi-1L and ABA-2L+ were -1,571 Japanese Yen (JPY) and 81 JPY, respectively. For ABA-1L versus TNFi-1L, ΔPMPM by ACR50 response was -11,715 JPY and by CDAI and SDAI remission 11,602 JPY and 47,003 JPY, respectively. Corresponding costs for ABA-1L were lower for all outcome parameters versus those for ABA-2L+. Scenario analyses showed that ABA-1L was cost-effective over TNFi-1L in patients <65 years for any outcome. Furthermore, ABA-1L was cost-effective over ABA-2L+ for all outcomes in patients with age <65 years, disease duration <5 years and J-HAQ ≥1.5. ABA-1L demonstrated a favourable cost-effectiveness profile in RA patients, accruing savings for the Japanese healthcare payers.

Dual antibody status predicts sustained remission in patients with rheumatoid arthritis

Background: Rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACCP) estimation have been used to improve the diagnosis of rheumatoid arthritis (RA). However, their role in prognostication of RA, individually and in combination, is not well studied. This is, especially, true for Indian patients. Methods: Consecutive 945 patients who had their RF and ACCP determined were included in the study. They were followed up for 3 months to 24 months. Swollen joint count, erythrocyte sedimentation rate, disease activity score 28 (DAS 28), and Indian version of Health Assessment Questionnaire (HAQ) were checked during each visit. They were treated with conventional disease-modifying agents (DMARDS). Results: At presentation, patients with both antibodies positive had the most severe disease, while those with both antibodies negative had the least severe disease. Among discordant antibody status (one antibody positive and the other negative), patients with ACCP positivity presented with higher disease activity than with RF positivity. Patients with dual antibody positivity were much less likely to be in remission than with both negative antibodies. The percentage of patients in remission were 34.2, 29.5, 32.4, and 24.7, respectively, for RF−/ACCP−, ACCP+/RF−, ACCP−/RF+, and ACCP+/RF+. Both, ACCP (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.74–0.78) and RF (OR: 0.68; 95% CI: 0.66–0.70) positivity were associated with lower odds of sustained remission (P Conclusion: Dual antibody-positive status at presentation carries poor prognosis, higher disease activity, higher HAQ score, and lesser chance of remission in RA patients with conventional treatment. Patients with both antibodies negative status had the best prognosis. Although patients with discordant antibody status had an intermediate prognosis, the ones with ACCP had higher disease activity at follow-up.

Association of Number of Fibromyalgia Tender Points With Health Status in Systemic Lupus Erythematosus (Sle) Patients

Fibromyalgia Tender Points (FMTPs) and functional health status measured by Health Assessment Questionnaire (HAQ) as well as health related quality of life by short form-36 (SF-36) in Systemic Lupus Erythematosus (SLE) patients have integrated adherent to each other. Comparison of fibromyalgia tender points and health status in many studies revealed remarkable correlation in both chronic rheumatologic diseases. We observed higher HAQ score and significant positive correlation between FMTP and HAQ score and we also found significant negative correlation in almost all domains of SF-36 with FMTP in SLE patients. Therefore, reduced functional status was found in SLE patients with higher FMTP count. To determine influence of the number of fibromyalgia tender points on functional health status as well as health related quality of life in SLE patients. The observational study carried out enrolling 67 female SLE patients and equal number of asymptomatic female subjects in Lupus Clinic of Rheumatology Wing, BSMMU, Dhaka from April 2005 to October 2006.After fulfilling the inclusion criteria with a detailed history and thorough physical examinations, obtained data were recorded in a pro-forma. 18 FMTP sites and 6 control sites were examined. Positive FMTP scores were recorded in a body chart. Culturally adopted and validated Bengali version of HAQ and SF-36 were filled-up to assess the self-reported health status. Both of the SLE patients and control subjects were classified into two subgroups. 0-10 FMTP’ group and &gt; 11 FMTP group. The HAQ score (Mean + SD) of SLE patients and of controls were 0.54 + 0.54 and 0.17 + 0.25 respectively. The difference was statistically significant (p &lt;0.001). The score (Mean + SD) of all domains’ of SF-36 in both the studied groups were also significantly different. In this SLE series significant correlation (R - + 0.390, p 0.001) was observed between HAQ score and FMTP. And significant correlation was also observed almost in all domains of SF-36 with FMTP. Health status in SLE patients was poor in those who have higher number of FMTP count. Health status was more reflective by SF-36 in comparison to HAQ. JCMCTA 2015 ; 26 (2) : 44 - 52

Profiles of EQ-5D utility scores in the daily practice of Japanese patients with rheumatoid arthritis; Analysis of the IORRA database

Objective. Along with the advances of newly developed medical therapies in rheumatoid arthritis (RA), the number of pharmacoeconomical issues has been paid attention rapidly. For cost–utility analysis and determination of quality-adjusted life years, measurement of the EuroQol 5-dimensional descriptive system (EQ-5D) is essential, and has been used in several clinical studies. However, EQ-5D utility measure in Japanese patients with RA, especially in daily practice has not been fully documented. We analyzed the distribution of EQ5D utility scores and investigated the relationship between other clinical measures based on our Institute of Rheumatology, Rheumatoid Arthritis (IORRA) database.Method. Among 5,284 outpatients who participated in the IORRA cohort study on October 2007, data from 5,043 patients who completed the EQ-5D questionnaire were cross-sectionally analyzed. EQ-5D scores in each subgroup for baseline feature such as gender, age, disease activity score 28 (DAS28), and Japanese version of health assessment questionnaire (J-HAQ) were evaluated. For the evaluation of variables that influenced EQ-5D score, the contribution of each variable was evaluated by ANOVA.Results. Average EQ-5D score was 0.76 in 5,284 patients (84% females, average age: 59.0 years, average disease duration: 12.4 years) whose average DAS28 was 3.3 and average J-HAQ was 0.74. EQ-5D scores were highly correlated with J-HAQ and DAS28, and were significantly lower in females and rheumatoid factor-positive patients. Older age, longer disease duration, higher DAS28, and higher J-HAQ were also significantly associated with lower EQ-5D scores. In multivariate analysis, the factor that most strongly influenced EQ-5D was J-HAQ (57.6%), followed by pain visual analog score (VAS; 12.5%).Conclusion. This study clearly demonstrated the distribution of EQ-5D score in the daily practice of RA patients, and provides important information for the pharmacoeconomical studies in rheumatology.

SAT0141 Vitamin D Deficiency is A Risk Factor for Carotid Atherosclerosis in Women with Rheumatoid Arthritis

BackgroundAlthough there is increasing evidence that low serum 25-hydroxy vitamin D (25-OHD) is associated with a higher frequency of cardiovascular diseases (CVDs) in the general population, little attention has been...

THU0458 Analysis of Genetic Factors Associated with Progression of Functional Disability in Japanese Patients with Rheumatoid Arthritis

BackgroundRheumatoid arthritis (RA) is characterized by chronic inflammation and joint destruction, resulting in deteriorated physical function. Genetic predisposition factors associated with the susceptibility to RA and the severity of joint...

Functional disability can deteriorate despite suppression of disease activity in patients with rheumatoid arthritis: a large observational cohort study

Objective To analyze the relationship between the progression of disability and disease activity in patients with rheumatoid arthritis (RA) in daily practice.Methods Patients from an observational cohort, IORRA, who completed surveys during 2009–2011 were eligible. Linear regression of disease activity score 28 (DAS28), Japanese version of Health Assessment Questionnaire (J-HAQ), and EQ-5D from baseline were calculated, and the angles of the regression lines were designated DAS28 slope, J-HAQ slope, and EQ-5D slope, respectively, in each patient; averages were compared between treatment groups.Results A total of 5,038 patients [84.0 % female, mean age 59.4 (SD 13.1) years, disease duration 13.2 (9.6) years, DAS28 3.29 (1.14), and J-HAQ 0.715 (0.760)] were analyzed. The average DAS28 slope indicated improvement in all groups, whereas J-HAQ slopes were negative in patients on methotrexate (MTX), biologics, combination biologics/disease-modifying antirheumatic drugs (DMARDs), and combination biologics/MTX at baseline, but positive in patients on prednisolone >5 mg/day [0.010 (0.153)] and not on MTX at baseline [0.007 (0.122)], representing a worsening of disability.Conclusion There is some disparity between improvement of disease activity and progression of disability, suggesting that quality of remission must be considered.

OP0152 Impact of comorbidities on both disease activity and treatment strategy in patients with rheumatoid arthritis: Analysis of the IORRA cohort database

BackgroundComorbidities decrease the opportunity to administer treatment strategies involving methotrexate (MTX) and biologics to patients with active rheumatoid arthritis (RA).ObjectivesTo clarify the impact of comorbidities on disease activity and treatment...

FRI0252 Severity of skin, tendon and joint damage in chinese patients with systemic sclerosis (SSC) is associated with higher disability and poorer health-related quality of life: A case-control study

ObjectivesTo study the disability and health-related quality of life (HRQoL) in Chinese patients with SSc, and its relationship with the extent of skin involvement and organ damage.MethodsConsecutive patients who fulfilled...

Prevalence of and factors associated with vitamin D deficiency in 4,793 Japanese patients with rheumatoid arthritis

To determine the prevalence of vitamin D deficiency and associations with clinical characteristics in Japanese patients with rheumatoid arthritis (RA), serum 25(OH)D levels, laboratory data, and clinical data were obtained from 4,793 patients with RA (4,075 women, 718 men, mean age 59.7 years) who participated in the Institute of Rheumatology Rheumatoid Arthritis observational cohort study in April and May of 2011. Serum vitamin D levels were evaluated using a radioimmunoassay. We defined vitamin D deficiency as <20 ng/mL and severe deficiency as <10 ng/mL. Associations of vitamin D deficiency with patient characteristics were examined using multivariate logistic regression. Among all patients, the mean (SD) serum 25(OH)D level was 16.9 ng/mL (6.1), and the prevalence of vitamin D deficiency and severe deficiency were 71.8 and 11.5%, respectively. In multivariate analysis, female gender, younger age, high Japanese version of health assessment questionnaire (HAQ) disability score, low serum total protein levels, low serum total cholesterol levels, high serum alkaline phosphate (ALP) levels, and non-steroidal anti-inflammatory drug (NSAID) use were significantly associated with vitamin D deficiency (P < 0.01). Vitamin D deficiency appears to be common in Japanese patients with RA, as previously reported for patients of other ethnicities. Female gender, younger age, high HAQ disability score, low serum levels of total protein and total cholesterol, high serum ALP levels, and NSAID use appear to be associated with vitamin D deficiency in Japanese patients with RA.

Functional disability can deteriorate despite suppression of disease activity in patients with rheumatoid arthritis: a large observational cohort study

To analyze the relationship between the progression of disability and disease activity in patients with rheumatoid arthritis (RA) in daily practice. Patients from an observational cohort, IORRA, who completed surveys during 2009-2011 were eligible. Linear regression of disease activity score 28 (DAS28), Japanese version of Health Assessment Questionnaire (J-HAQ), and EQ-5D from baseline were calculated, and the angles of the regression lines were designated DAS28 slope, J-HAQ slope, and EQ-5D slope, respectively, in each patient; averages were compared between treatment groups. A total of 5,038 patients [84.0% female, mean age 59.4 (SD 13.1) years, disease duration 13.2 (9.6) years, DAS28 3.29 (1.14), and J-HAQ 0.715 (0.760)] were analyzed. The average DAS28 slope indicated improvement in all groups, whereas J-HAQ slopes were negative in patients on methotrexate (MTX), biologics, combination biologics/disease-modifying antirheumatic drugs (DMARDs), and combination biologics/MTX at baseline, but positive in patients on prednisolone >5 mg/day [0.010 (0.153)] and not on MTX at baseline [0.007 (0.122)], representing a worsening of disability. There is some disparity between improvement of disease activity and progression of disability, suggesting that quality of remission must be considered.

Fatigue and severity of rheumatoid arthritis in Moroccan patients

The aim of this study was to assess fatigue aspects in Moroccan patients with rheumatoid arthritis (RA) and its relationships with disease-specific variables especially parameters of functional and structural severity. A total of 248 patients with RA were included. Patients' and disease characteristics were identified. Disease activity was measured clinically using physical examination, biologically and by the disease activity scores (DAS28). Radiographs were evaluated by using Sharp's method as modified by van der Heijde. Functional disability was measured by using the Moroccan version of Health Assessment Questionnaire (HAQ). Immunological abnormalities and treatment (doses and duration) were identified. Fatigue was evaluated by using a 0-100 visual analogue scale (VAS fatigue) and the multidimensional assessment of fatigue (MAF). Quality of life (QoL) was assessed using the Arabic version of the generic instrument SF-36. The mean age of patients was 47.5 ± 11.7 years [25-72]; 37.5% of patients had a high activity of disease and 11.3% were in remission. The mean Sharp score was 107.13 ± 91, and the mean score of HAQ was 1.40 ± 0.63. All domains of QoL were deteriorated; 89.51% of our patients experienced fatigue. The mean total score of MAF was 30.21 ± 11.32. A low level of education, low socioeconomic status, atlantoaxial subluxation, hip involvement, the presence of a Sjögren syndrome, and cigarette smoking had a negative impact on fatigue scores. The severity of fatigue was correlated with the duration of RA, the intensity of joint pain, the activity of disease, the importance of structural damage, the degree of functional impairment, and the rate of anti-cyclic citrullinated protein (CCP) antibodies (P < 0.05). Patients receiving methotrexate had better scores of fatigue. Also, severity of fatigue was correlated with the deterioration of all domains of QoL. Fatigue is a major issue for our patients with RA and must be included in the routine assessment of patients. In our sample, fatigue appears to be related to disease activity, functional disability, structural damage, and immunological status and had a negative impact on QoL.

Effects of long-term corticosteroid usage on functional disability in patients with early rheumatoid arthritis, regardless of controlled disease activity

We investigated the effect of long-term corticosteroid usage in suppressing the progression of functional disability in patients with early rheumatoid arthritis (RA). We studied 3,982 RA patients, who had continuous enrollment for at least 3 years, among 9,132 RA patients enrolled in an observational cohort study, IORRA, in Tokyo, Japan, from 2000 to 2007. The DAS28 and Japanese version of Health Assessment Questionnaire (J-HAQ) scores were collected at 6-month intervals (each phase). Among these patients, those with DAS28 values under 3.2 in all phases and RA disease duration under 2 years at study entry were selected as "early RA patients with well-controlled disease". These patients were further classified into 3 groups based on average months of steroid usage per year: Non-users, Medium-users, and Frequent-users. Multiple linear regression analysis was used to study the relationship between steroid usage and the final J-HAQ scores. Among the 3,982 patients, 109 had DAS28 values under 3.2 in all the phases and were selected as study cohort. The average Final J-HAQ in Non-user (N = 64), in Medium-user (N = 25), in Frequent-user group (N = 20) was 0.04, 0.06, and 0.33, respectively. Multiple linear regression analysis after adjusting for all potential covariates confirmed that frequent steroid usage was the most significant factor associated with higher final J-HAQ scores (P < 0.05). Frequent steroid usage was associated with significantly higher final J-HAQ scores in early RA patients, even though their disease was managed efficiently by maintaining the DAS28 values under 3.2 over a long-term period.

Medical care costs of patients with rheumatoid arthritis during the prebiologics period in Japan: a large prospective observational cohort study

Our objective was to describe outpatient medical care costs of patients with rheumatoid arthritis (RA) in the prebiologics period in Japan. The outpatient costs of 6,771 RA patients (17,666 patient years) who were enrolled in an observational cohort study at the Institute of Rheumatology, Rheumatoid Arthritis (IORRA), in Tokyo, Japan, were calculated from the billing records dated from 2000 to 2004. Associations between outpatient costs and variables such as age, RA duration, RA disease activities, and disability levels were assessed. The average outpatient cost gradually increased (+7.7% in 4 years) from 271,498 JPY per year in 2000 to 292,417 JPY per year in 2004. Medications accounted for approximately 50% of total outpatient costs, which increased 29.6% during the 4 years. The outpatient costs increased in association with aging, longer RA duration, higher Disease Activity Score of 28 Joints (DAS28), and higher Japanese version of Health Assessment Questionnaire (J-HAQ) score. Generalized linear regression analysis revealed that both DAS28 and J-HAQ scores were the most significant factors associated with outpatient costs (p < 0.001). Outpatient costs for patients with RA increased year after year over the 4-year period under observation in Japan. Medical costs were higher with increasing RA disease activity and disability levels.

Medical care costs of patients with rheumatoid arthritis during the prebiologics period in Japan: a large prospective observational cohort study

Our objective was to describe outpatient medical care costs of patients with rheumatoid arthritis (RA) in the prebiologics period in Japan. The outpatient costs of 6,771 RA patients (17,666 patient years) who were enrolled in an observational cohort study at the Institute of Rheumatology, Rheumatoid Arthritis (IORRA), in Tokyo, Japan, were calculated from the billing records dated from 2000 to 2004. Associations between outpatient costs and variables such as age, RA duration, RA disease activities, and disability levels were assessed. The average outpatient cost gradually increased (+7.7% in 4 years) from 271,498 JPY per year in 2000 to 292,417 JPY per year in 2004. Medications accounted for approximately 50% of total outpatient costs, which increased 29.6% during the 4 years. The outpatient costs increased in association with aging, longer RA duration, higher Disease Activity Score of 28 Joints (DAS28), and higher Japanese version of Health Assessment Questionnaire (J-HAQ) score. Generalized linear regression analysis revealed that both DAS28 and J-HAQ scores were the most significant factors associated with outpatient costs (p < 0.001). Outpatient costs for patients with RA increased year after year over the 4-year period under observation in Japan. Medical costs were higher with increasing RA disease activity and disability levels.

Psychometric evaluation of a Moroccan version of health assessment questionnaire for use in Moroccan patients with rheumatoid arthritis

Objective of the study is to test the reliability and validity of a translated version of health assessment questionnaire (HAQ) on Moroccan patients with rheumatoid arthritis (RA). We led a prospective study from July 2004 to September 2005. A total of 100 Moroccan patients were recruited. After translation to dialect Arabic, back translation, expert committee review and pretesting of the questionnaire, it was administered to the selected patients and tested for construct validity, reliability and internal consistency. The construct validity was evaluated by correlating the yield of the questionnaire with other disease activity and severity parameters. The questionnaire was administered again after a time interval of between 2 and 10 days for evaluation of the reliability of this test. All the items were tested for their loyalty to the principal component. The adapted questionnaire showed a good internal consistency. Cronbach's alpha test was 0.994. The test-retest showed a strong reliability with a kappa test ranging from 0.70 to 0.92 for all domains. Intraclass correlation coefficient for the total score was 0.987. The Moroccan HAQ showed a strong validity. It correlates significantly with disease activity and severity parameters. The unidimentionality has been demonstrated. About 71.5% of all variabilities was accounted for by the first principal component. The Moroccan Arabic dialect version of HAQ is a reliable and valid instrument that can be self-administered by Moroccan RA patients to assess their functional disability.

Comparison of the Indian version of Health Assessment Questionnaire Score and Short Form 36 Physical Function Score in rheumatoid arthritis using Rasch analysis

Objective The health assessment questionnaire (HAQ) has been modified by many investigators to suit the culture and lifestyle of Indian population and these have been validated using traditional approaches. The goal of this study was to further validate the Indian version of HAQ published in 2002 by modern psychometric analysis, specifically by examining fit of the scale's data to the Rasch measurement model. Methods A cross-sectional study was performed on 46 patients with rheumatoid arthritis (RA) from a single center in western India. Demographic characteristics, pain score and global perception of health were recorded on visual analogue scale. Functional outcome was assessed with the Indian HAQ and Short Form 36 physical function (SF 36-PF). Rasch analysis was performed to examine the property of various measures and to compare them on a common scale. Result The mean age ± SD was 45 ± 14.19 years and mean duration was 35.5 ± 52 months. 82.6% were women. The Indian HAQ highly correlated with SF 36-PF ( r = 0.812, P < 0.001). Both the indices showed a moderate correlation with fatigue, pain, global health perception as well as disease activity scores (DAS28). Both the indices satisfied the Rasch model and were unidimensional with adequate person separation and reliability. Nine out of the 12 items in Indian HAQ were fitting in the Rasch model while in SF 36-PF scale nine out of 10 were fitting in the Rasch model. Three items in the HAQ (a) sitting cross-legged, (b) bending, and (c) lifting a cup were not fitting in the Rasch model, while one item of SF 36 ‘walking one block’, was not fitting in the Rasch model. 2.2% of patients assessed by Indian HAQ had 0 score (floor effect), while none had 3 score (ceiling effect), while 15.2% had maximum SF 36-PF score (ceiling effect) while none had 100 score (floor effect). Conclusion Both Indian HAQ and SF 36-PF provide unidimensional measure of physical functioning in RA. SF 36-PF has significant psychometric advantage over Indian HAQ in RA in our cohort.

High prevalence of metabolic syndrome in patients with ankylosing spondylitis

The objective of this work is to investigate the occurrence of atherosclerosis and metabolic syndrome (MetS) in ankylosing spondylitis (AS) patients (pts). Twenty-four consecutive AS pts (men, 87.5%; median age, 50.5 years; median disease duration, 16.5 years), fulfilling the modified 1984 New York criteria for AS criteria, and 19 age- and sex-matched controls were investigated. Clinical atherosclerosis was evaluated by physical examination for cardiovascular (CV) diseases and history or drug use for CV events. Subclinical atherosclerosis was detected by mean intima media thickness (a-IMT) and maximum IMT (max-IMT) of carotid arteries using ultrasonography. Laboratory investigations including fasting plasma glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides were assessed by standard methods, while homocysteine was assessed by chemiluminescence. MetS was assessed using the updated NCEP-ATP III criteria. Disease activity was defined according to the International Ankylosing Spondylitis Assessment Study criteria. The 10-year CV risk (%) profile was evaluated in agreement to the Progetto Cuore criteria. No major CV event was detected in the study population. No significant differences were found when AS pts and controls were compared according to the mean a-IMT (0.52+/-0.26 vs 0.51+/-0.13 mm), max-IMT (0.92+/-0.20 vs 0.85+/-0.39 mm), prevalence of abnormal max-IMT >1 mm (27.2 vs 5.3%), and 10-year CV risk (9.9+/-9.6 vs 3.6+/-1.8%). Systolic blood pressure (p=0.04), triglyceride to HDL cholesterol ratio (p=0.002), and LDL cholesterol (p=0.03) were found significantly higher in AS pts than in controls; on the contrary, HDL cholesterol was pointed out as significantly lower (p<0.001). MetS was found in 11/24 (45.8%) AS pts and in 2/19 (10.5%) controls (p=0.019). No significant relationship emerged in MetS prevalence among AS pts regarding the mean value of age, disease duration, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, and the Italian version of Health Assessment Questionnaire. This preliminary report points out a higher prevalence of MetS in AS pts than in controls. Further studies are needed to confirm this finding.