Validity of adopting a Health Assessment Questionnaire Disability Index less than 0.5 as a target in elderly rheumatoid arthritis patients
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The effect of age on the Health Assessment Questionnaire Disability Index (HAQ-DI) scores of rheumatoid arthritis (RA) patients and the validity of adopting HAQ-DI < 0.5 as the target for functional remission and comprehensive disease control (CDC) under a treat-to-target (T2T) treatment strategy were investigated.
A total of 441 RA patients with > 3-year treatment under T2T were evaluated. The relationships between the HAQ-DI score at follow-up (HAQ) and 28-joint Disease Activity Score with C-reactive protein, Sharp/van der Heijde Score, age at follow-up, and HAQ-DI at baseline were statistically evaluated with best subset regression analysis in groups separated according to age and the EULAR response. CDC status was evaluated with a chi-square test.
The HAQ score significantly correlated with all indices in the group ≥ 65 years old (G-O) and in the group with good or moderate EULAR responses (p < 0.01). No significant correlation was observed in the group < 65 years old (G-Y) or in the group with no EULAR response. The CDC ratio was not significantly different between the age groups, whereas the HAQ failure ratio was significantly greater in G-O than in G-Y (p < 0.01). No significant difference was found between the EULAR response groups.
• ADL in elderly RA patient aged ≥ 65 years declines corresponding to his/her aging.
• Functional remission for elderly RA patients is not the same as that for young RA patients.
• The HAQ score < 0.5 in elderly RA patient is not an appropriate target for CDC.
KeywordsActivities of daily living Aging Comprehensive health care Rheumatoid arthritis
The authors would like to thank Kaoru Kuwabara, Sayori Masuoka, and Mariko Osaki for their dedicated data collection.
Compliance with ethical standards
This study was conducted in compliance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects of Japan under the Declaration of Helsinki. The Ethics Committee of the institution approved the protocol and consent forms (approval number: YH-RA-201803). Patients and their families were informed that personal information would be anonymous and used only for analysis before they signed the consent forms.
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