The characteristics and associated factors of functional limitation in patients with rheumatoid arthritis / 中华内科杂志

Objective:To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis (RA).Methods:Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. Demographic and clinical characteristics including age, gender, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, clinical disease activity index (CDAI), modified total Sharp score were collected. Physical function was assessed by the Stanford health assessment questionnaire disability index (HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI.Results:A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age (49.7±12.9) years. There were 399 (62.1%) patients having different degrees of functional limitation, who were classified as mild (293, 45.6%), moderate (73, 11.4%) and severe (33, 5.1%). The prevalence of functional limitation was positively correlated with age and disease activity. The most restricted activity was walking [43.5% (280/643)], followed by gripping [36.1% (232/643)], reaching [35.5% (228/643)], daily activities [33.4% (215/643)], hygiene [33.0% (212/643)], dressing and grooming [29.7% (191/643)] and arising [29.1% (187/643)], and the last eating [18.4% (118/643)]. Multivariate ordered logistic regression analysis showed that age ( OR=1.019, 95% CI 1.004-1.035),pain VAS ( OR=1.820, 95% CI 1.616-2.050), ESR ( OR=1.009, 95% CI 1.001-1.017), CDAI ( OR=1.080, 95% CI 1.059-1.102) and modified total Sharp score ( OR=1.010, 95% CI 1.004-1.015) were associated factors of functional limitation. Conclusion:The majority RA patients have functional limitation. Age, pain and active disease are independent associated factors. Therefore, target treatment and control of pain should be emphasized in RA patients.

Disease knowledge and functional disability of a cohort of rheumatoid arthritis in a tertiary government hospital in Manila, Philippines

Background@#Rheumatoid arthritis (RA) is a chronic and progressive disease resulting in disability and poor quality of life. Patients’ knowledge (PxK) of disease can contribute to better disease control, reduced disability, and improved quality of life. @*Objective@#The objective of this study was to determine the disease knowledge and functional disability of a cohort of patients with RA. @*Methods@#We conducted a cross-sectional study among patients with RA at the University of the Philippines - Philippine General Hospital Arthritis Clinic. The subjects were recruited using convenience sampling over three months in 2019. We obtained demographic and disease characteristics, clinic attendance, patient knowledge, and functional status through chart review, a questionnaire, and a disability index. Descriptive statistics, 2-sample T-test, Pearson’s correlation, analysis of variance (ANOVA), and multiple linear regression analysis were used for data analysis. Informed consent was obtained before participation in the study. @*Results@#Eighty percent (57/71) of recruited patients participated in the study. All were female, and the mean age was 51.6 years (±12.9). Most participants completed secondary education, were employed, had an average duration of RA of 8 (±6.8) years, had been consulting at the Arthritis Clinic for an average of 4.8 years (±3.8), and had moderate disease activity (49.1%). Most patients had American College of Rheumatology (ACR) class I or II functional status (50/57, 88%). The usual source of the patients' knowledge about RA was their physician. The mean knowledge score was 5.10 (±0.93) out of a perfect score of 9. Most patients were aware of their disease diagnosis and the non-communicable nature of RA. There was low awareness of the need for self-monitoring for disease flares or treatment adverse events and the extra-articular involvement in RA. The mean functional disability score was 6.65 ± 5.33, and the mean functional disability index (FDI) was 0.83 (±0.66). These correspond to mild functional disability (FD). There was no significant relationship between the total knowledge score and age, duration of disease, number of consultations in the past year, level of education, employment status, perceived level of disease knowledge, or the practice of asking their physician about illness. Perception of overall health status was associated with functional disability (p=0.001). @*Conclusion@#Most of the patients in our cohort of RA patients had a mild functional disability and low knowledge scores. The study identified the gaps in our patients’ knowledge of disease and its management. A re-evaluation of existing educational and treatment strategies will be beneficial to enhance disease knowledge and improve health outcomes.

Clinical value of multi-dimensional health assessment questionnaire in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective To evaluate the clinical value of Chinese Multi-Dimensional Health Assessment Questionnaire (MDHAQ-C) in patients with rheumatoid arthritis (RA). Methods From December 2015 to October 2016,four hundred and twelve RA patients were recruited in this study and completed the MDHAQ-C independently and routine assessment of patient index data 3 (RAPID3) was calculated. Then correlations were assessed by Spearman correlation coefficient of RAPID3 with indices of clinical relevance and disease activity to evaluate its clinical values. Results MDHAQ-C is moderately correlated with ESR (r=0.399), CRP (r=0.381), SJC (r=0.499), TJC (r=0.558) (P<0.01), but highly correlation with VAS of pain (r=0.836), VAS of global status (r=0.915) and overall assessment of physician (r=0.784)(P<0.01), and highly correlated with a Spearman's coefficient of 0.784 for DAS 28-ESR, 0.734 for CDAI and 0.682 for SDAI (P<0.001). Conclusion MDHAQ is a reliable, valid instrument for disease activity assessment and a feasible index for clinical settings in Chinese RA patients.

Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis

Patient self-report questionnaires such as a multidimensional health assessment questionnaire (MDHAQ) have advanced knowledge concerning prognosis, care, course and outcomes of rheumatoid arthritis (RA). The MDHAQ may overcome some limitations of a "biomedical model," the dominant paradigm of contemporary medical services, including limitations of laboratory tests, radiographs, joint counts, and clinical trials, to predict and depict the long-term course and outcomes of RA. A complementary "biopsychosocial model" captures components of a patient medical history on patient questionnaires as quantitative, standard, "scientific" scores for physical function, pain, fatigue, and other problems, rather than as 'subjective" narrative descriptions. A rationale for a biopsychosocial model in RA includes the importance of a patient history in diagnosis and management compared to biomarkers in many chronic diseases such as hypertension and diabetes. Some important observations which support a biopsychosocial model in RA based on patient questionnaires include that MDHAQ physical function scores are far more significant than radiographs or laboratory tests to predict severe RA outcomes such as work disability and premature death; patient self-report measures are more efficient than tender joint counts and laboratory tests to distinguish active from control treatments in RA clinical trials involving biological agents; and MDHAQ scores are more likely than laboratory tests to be abnormal at presentation and to document incomplete responses to methotrexate at initiation of biological agents. Patient questionnaires can save time for doctors and patients, and improve doctor-patient communication. A standardized database of MDHAQ scores consecutive patients over long periods might be considered by all rheumatologists in routine clinical care.

A gravidade e a região da lesão corporal correlacionam com resultados a longo prazo em paciente com traumatismo grave? / Do the severity and the body region of injury correlate with long-term outcome in the severe traumatic patient? / ¿La gravedad y la región de la lesión corporal se correlacionan conlos resultados a largo plazo en un paciente con traumatismo grave?

Justificativa e objetivos: investigar se o índice de gravidade da lesão (ISS) e a escala abreviada de lesões (AIS) estão correlacionados com a qualidade de vida em longo prazo em pacientes com traumatismo grave. Métodos: pacientes que sofreram lesões de 2005 a 2007, com IGL≥15, foram pesquisados 16-24 meses após as lesões. O questionário de avaliação da saúde (HAQ-DI) foi usado para medir o estado funcional e o modelo abreviado do questionário com 12 itens (Short Form-12 [SF-12]) foi usado para medir o estado de saúde dividido em seus dois componentes: o resumo do componente saúde física (PCS) e o resumo do componente saúde mental (MCS). Os resultados dos questionários foram comparados com os componentes do ISS e da AIS. Os resultados do SF-12 foram comparados com os valores esperados da população geral. Resultados: preencheram os questionários 74 pacientes (taxa de resposta de 28%). A média dos escores foi: PCS 42,6 ± 13,3; MCS 49,4 ± 1,4; HAQ-DI 0,5 ±0,7. Houve correlação com HAQ-DI e PCS (Rho de Spearman: -0,83; p < 0,05) e nenhuma correlação entre HAQ-DI e MCS ou entre MCS e PCS (Rho de Spearman = -0,21 e 0,01, respectivamente). Os escores cutâneo-externo e extremidades-pélvico da AIS correlacionaram com o PCS (Rho de Spearman: -0,39 e -0,34, p < 0,05) e com o HAQ-DI (Rho de Spearman: 0,31 e 0,23; p < 0,05). A condição física em comparação com a população normal foi pior, exceto para os grupos com idades entre 65-74 e 55-64 anos. Conclusões: os pacientes com fraturas pélvicas e de extremidades são mais propensos a apresentar incapacidade em longo prazo. A gravidade das lesões externas influenciou a deficiência em longo prazo. .

Background and objectives: To investigate if the Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) are correlated with the long-term quality of life in severe trauma patients. Methods: Patients injured from 2005 to 2007 with an ISS ≥ 15 were surveyed 16-24 months after injury. The Health Assessment Questionnaire (HAQ-DI) was used for measuring the functional status and the Short Form-12 (SF-12) was used for measuring the health status divided into its two components, the PCS (Physical Component Summary) and the MCS (Mental Component Summary). The results of the questionnaires were compared with the ISS and AIS components. Results of the SF-12 were compared with the values expected from the general population. Results: Seventy-four patients filled the questionnaires (response rate 28%). The mean scores were: PCS 42.6 ± 13.3; MCS 49.4 ± 1.4; HAQ-DI 0.5 ± 0.7. Correlation was observed with the HAQ-DI and the PCS (Spearman's Rho: -0.83; p < 0.05) and no correlation between the HAQ-DI and the MCS neither between the MCS and PCS (Spearman's Rho = -0.21; and 0.01 respectively). The cutaneous-external and extremities-pelvic AIS punctuation were correlated with The PCS (Spearman's Rho: -0.39 and -0.34, p < 0.05) and with the HAQ-DI (Spearman's Rho: 0.31 and 0.23; p < 0.05). The physical condition compared with the regular population was worse except for the groups aged between 65 -74 and 55 -64. Conclusions: Patients with extremities and pelvic fractures are more likely to suffer long-term disability. The severity of the external injuries influenced the long-term disability. .

Justificación y objetivos: investigar si el Índice de Gravedad de la Lesión (Injury Severity Score [ISS]) y la Escala Abreviada de Lesiones (Abbreviated Injury Score [AIS]) están correlacionados con la calidad de vida a largo plazo en pacientes con traumatismo grave. Métodos: pacientes que sufrieron lesiones entre 2005 y 2007, con un ISS ≥ 15, fueron encuestados 16-24 meses después de las lesiones. Se usó el Cuestionario de Evaluación de la Salud-Índice de Incapacidad (Health Assessment Questionnaire-Disability Index [HAQ-DI]) para medir el estado funcional, y el modelo abreviado del cuestionario con 12 ítems (Short Form-12 [SF-12]) para medir el estado de salud dividido en 2 componentes: el índice de salud física (Physical Component Summary [PCS]) y el índice de salud mental (Mental Component Summary [MCS]). Los resultados de los cuestionarios fueron comparados con los componentes del ISS y del AIS. Los resultados del SF-12 fueron comparados con los valores esperados en la población general. Resultados: setenta y cuatro pacientes rellenaron los cuestionarios (tasa de respuesta de un 28%). Las puntuaciones medias fueron: PCS 42,6 ± 13,3; MCS 49,4 ± 1,4; HAQ-DI 0,5 ± 0,7. Se registró una correlación con HAQ-DI y PCS (rho de Spearman: −0,83; p < 0,05) y ninguna correla-ción entre HAQ-DI y MCS o entre MCS y PCS (rho de Spearman = −0,21; y 0,01, respectivamente). Las puntuaciones cutáneo-externas y extremidades-pélvicas de la AIS se correlacionaron con el PCS (rho de Spearman: −0,39 y −0,34; p < 0,05) y con el HAQ-DI (rho de Spearman: 0,31 y 0,23; p < 0,05). La condición física en comparación con la población normal fue peor, excepto para los grupos con edades entre 65-74 y 55-64 años. Conclusiones: los pacientes con fracturas pélvicas y de extremidades ...

Validity of Estimating EuroQol (EQ5D) from a Health Assessment Questionnaire (HAQ) / 대한류마티스학회지

OBJECTIVE: Assessment of health-related quality of life in patients with rheumatoid arthritis (RA) has become important in health research. Health economists have used linear regression equations to mathematically transform changes in HAQ scores into EQ5D data, which can be used to calculate quality adjusted life years (QALYs). We aimed to examine whether a given approach is justified. METHODS: A total of 223 patients with RA were recruited from the Hospital for Rheumatic Diseases at Hanyang University. They completed the HAQ and EQ5D and a correlation analysis was performed between the two instruments. We compared HAQ and EQ5D score changes for patients who completed the EQ5D and HAQ at first and second visits (n=159). Predicted EQ5D was estimated from the HAQ using the calculating method of Bansnack et al. The mean difference between the predicted EQ5D from the HAQ and observed health utility score at the first visit and change during the study were tested by the paired t-test. RESULTS: In the cross-sectional study, EQ5D scores were moderately inversely correlated with HAQ (r=-0.716, p<0.001). However, the predicted EQ5D from the HAQ was significantly different from the observed EQ5D (p=0.001; 95% confidence interval [CI] 0.020~0.079). The change in EQ5D was also inversely correlated with the change in the HAQ (r=-0.615, p<0.001), and change in the predicted EQ5D scores corresponded well with changes in observed health utility scores (p=0.155; 95% CI (-0.0873~0.0140). CONCLUSION: Changes in predicted EQ5D corresponded with observer changes in EQ5D, suggesting that it may be better to use predicted EQ5D form HAQ to identify change in the quality of life.

Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease activity and bone erosion / 中华风湿病学杂志

Objective To compare the correlation between anti-cyclic citrulinated peptide antibody (anti-CCP), rheumatoid factor (RF) and disease activity, functional capacity, bone erosion of rheumatoid arthritis (RA). Methods The correlation between anti-CCP, RF and disease activity score 28 (DAS28),health assessment questionnaire(HAQ) and bone erosion was assessed. Results Among the 218 RA patients,76% were anti-CCP-positive and 71% were RF-positive. The mean DAS28 score of RA patients with anti-CCP-positive and RF-positive was significantly higher than patients without anti-CCP and RF. The serum an-ti-CCP levels and RF levels showed a significant correlation with DAS28 score. However, the HAQ scores, ESR and CRP levels showed no significant difference between anti-CCP-positive and anti-CCP-negafive patients, RF-positive and RF-negative patients. Among anti-CCP-positive RA patients, the number of patients with erosive disease was significantly higher than patients without anti-CCP. However, the number of patients with erosive disease was not significantly different between RF-positive and RF-negative patients. Conclusion Anti-CCP and RF arc associated with disease activity. Anti-CCP is associated with bone erosion. No association is found between RF and bone erosion.

Complementary and Alternative Medicine Use and Its Usefulness in Patients with RA / 대한류마티스학회지

OBJECTIVE: The use of Complementary and Alternative Medicine (CAM) is common especially among patients with chronic conditions. The aim of this study was to investigate the percentage and characteristics of patients who make use of CAM and analyse the effect of CAM in RA. METHODS: Two hundreds and twelve patients with RA were interviewed by a trained nurse according to structured questionnaire about sociodemographic features and type, effect and cost of CAM which was used. RESULTS: Among 212 patients with RA, 73 patients had used CAM (34.4%). There was no difference in sociodemographic features between the user and non-user of CAM. The chinese medicine containing herbal medicine and acupuncture (43.8% and 24.7%) was most commonly used. There was no difference in the score of Korean Health Assessment Questionnaire (KHAQ) between the user and non-user of CAM. In the user group, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. The average yearly cost for CAM was 790,000 Won/person and it was about 67.5% of the one for hospital services. CONCLUSION: In patients with RA, the percentage of using CAM was 34.4%. Herbal medicine was most commonly used. CAM did not affect the outcome of the patients with RA. However, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. For the proper management of patients with RA, it is necessary to know further data about the effectiveness and side effects of CAM through experimental and clinical research.