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Potential of the HAQ score as clinical indicator suggesting comprehensive multidisciplinary assessments: the Swedish TIRA cohort 8 years after diagnosis of RA

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Abstract

This study explores the potential of the health assessment questionnaire (HAQ) score as a clinical indicator that can be used to suggest comprehensive multidisciplinary assessments, by relating it to more general aspects of disability. In a cohort of 132 patients with early RA (mean age 55, 68% women), 28 joint count Disease Activity Scores (DAS-28), HAQ, and Short Form 36 (SF-36) scores were registered at annual follow-up visits 8 years after diagnosis. The patients were tentatively sub-grouped into a high-HAQ group (HAQ ≥1 at the 8-year follow-up) and a low-HAQ group. The high-HAQ group, comprising 36% of the cohort, had a higher mean HAQ score at inclusion and beyond at all visits compared to the low-HAQ group, and 24% of all individual patients in the high-HAQ group had a HAQ score ≥1 at inclusion. Although the DAS-28 improved in both groups, patients in the high-HAQ group also had significantly more persistent disability according to the SF-36: five scales at each follow-up visit and all eight scales at the majority of the visits. Individual RA patients with HAQ ≥1 probably have considerable persistent disabilities according to the SF-36. The HAQ score could be used as a clinical indicator suggesting comprehensive multidisciplinary assessments of the components of disability and corresponding interventions, in addition to the established use of HAQ at group levels and in parallel with the medication strategy based on DAS-28.

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References

  1. Thyberg I, Skogh T, Hass UA, Gerdle B (2005) Recent-onset rheumatoid arthritis: a 1-year observational study of correlations between health-related quality of life and clinical/laboratory data. J Rehabil Med 37:159–165

    PubMed  Google Scholar 

  2. Eberhardt K, Larsson BM, Nived K, Lindqvist E (2007) Work disability in rheumatoid arthritis—development over 15 years and evaluation of predictive factors over time. J Rheumatol 34:481–487

    PubMed  Google Scholar 

  3. Björk MA, Thyberg IS, Skogh T, Gerdle BU (2007) Hand function and activity limitation according to health assessment questionnaire in patients with rheumatoid arthritis and healthy referents: 5-year followup of predictors of activity limitation (The Swedish TIRA Project). J Rheumatol 34:296–302

    PubMed  Google Scholar 

  4. Sokka T, Toloza S, Cutolo M et al (2009) Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther 11:R7

    PubMed  Google Scholar 

  5. Björk M, Thyberg I, Rikner K, Balogh I, Gerdle B (2009) Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project. J Rheumatol 36:1170–1179

    Article  PubMed  Google Scholar 

  6. Sokka T, Kautiainen H, Pincus T et al (2010) Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 12:R42

    Article  PubMed  Google Scholar 

  7. Hafström I, Bala V, Albertsson K, Forslind K, Svensson B, BARFOT Study Group (2011) Joint destruction in early rheumatoid arthritis over 8 years is similar in women and men despite apparently higher disease activity and poorer function in women. Ann Rheum Dis 70:709–710

    Article  PubMed  Google Scholar 

  8. Strand V, Khanna D (2010) The impact of rheumatoid arthritis and treatment on patients’ lives. Clin Exp Rheumatol 28(3 Suppl 59):32–40

    Google Scholar 

  9. Kosinski M, Kujawski SC, Martin R, Wanke LA, Buatti MC, Ware JE Jr, Perfetto EM (2002) Health-related quality of life in early rheumatoid arthritis: impact of disease and treatment response. Am J Manag Care 8:231–240

    PubMed  Google Scholar 

  10. Sesin CA, Bingham CO (2005) Remission in rheumatoid arthritis: wishful thinking or clinical reality? Semin Arthritis Rheum 35:185–196

    Article  PubMed  Google Scholar 

  11. Combe B (2007) Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol 21:27–42

    Article  PubMed  Google Scholar 

  12. Laas K, Peltomaa R, Puolakka K, Kautiainen H, Leirisalo-Repo M (2009) Early improvement of health-related quality of life during treatment with etanercept and adalimumab in patients with rheumatoid arthritis in routine practice. Clin Exp Rheumatol 27:315–320

    PubMed  CAS  Google Scholar 

  13. Ziegler S, Huscher D, Karberg K, Krause A, Wassenberg S, Zink A (2010) Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997–2007: results from the National Database of the German Collaborative Arthritis Centres. Ann Rheum Dis 69:1803–1808

    Article  PubMed  Google Scholar 

  14. Van der Kooi E, Klarenbeek NB, Guler-Yuksel M, Kerstens PJ, van der Lubbe PA, Westedt ML, ten Wolde S, Huizinga TW, Dijkmans BA, Allaart CF (2011) A decrease in disease activity score (DAS) level is associated with a decrease in health assessment questionnaire (HAQ) score, independent of follow-up duration, during 5 years of tightly controlled treatment: results from the BeSt study. Ann Rheum Dis 70:168–171

    Article  PubMed  Google Scholar 

  15. Neovius M, Simard JF, Askling J (2011) Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden. Ann Rheum Dis 70:624–629

    Article  PubMed  Google Scholar 

  16. Kastbom A, Strandberg L, Skogh T (2004) Anti-CCP antibody test predicts the disease course during 3 years in early rheumatoid arthritis (the Swedish TIRA project). Ann Rheum Dis 63:1085–1089

    Article  PubMed  CAS  Google Scholar 

  17. Aletaha D, Machold KP, Nell VPK, Smolen JS (2006) The perception of rheumatoid arthritis core set measures by rheumatologists. Results of a survey. Rheumatology 45:1133–1139

    Article  PubMed  CAS  Google Scholar 

  18. Thyberg I, Dahlström Ö, Thyberg M (2009) Factors related to fatigue in women and men with early rheumatoid arthritis: the Swedish TIRA study. J Rehabil Med 41:904–912

    Article  PubMed  Google Scholar 

  19. Michaud K, Wallenstein G, Wolfe F (2011) Treatment and nontreatment predictors of Health Assessment Questionnaire disability progression in rheumatoid arthritis: a longitudinal study of 18,485 patients. Arthritis Care Res 63:366–372

    Google Scholar 

  20. WHO (2001) International classification of functioning, disability and health. World Health Organization, Geneva

    Google Scholar 

  21. Margaretten M, Barton J, Julian L, Katz P, Trupin L, Tonner C, Graf J, Imboden J, Yelin E (2011) Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis. Arthritis Care Res 63:240–246

    Article  CAS  Google Scholar 

  22. Hammond A (2004) Rehabilitation in rheumatoid arthritis: a critical review. Musculoskeletal Care 2:135–151

    Article  PubMed  Google Scholar 

  23. Stamm TA, Cieza A, Coenen M, Machold KP, Nell VP, Smolen JS, Stucki G (2005) Validating the International Classification of Functioning, Disability and Health Comprehensive Core Set for Rheumatoid Arthritis from the patient perspective: a qualitative study. Arthritis Rheum 53:431–439

    Article  PubMed  Google Scholar 

  24. Vliet Vlieland TP (2007) Non-drug care for RA: is the era of evidence-based practice approaching? Rheumatology (Oxford) 46:1397–1404

    Article  Google Scholar 

  25. Stucki G, Cieza A, Melvin J (2007) The International Classification of Functioning, Disability and Health: a unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med 39:279–285

    Article  PubMed  Google Scholar 

  26. Vliet Vlieland TPM, Pattison D (2009) Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 23:103–116

    Article  PubMed  Google Scholar 

  27. Radner H, Smolen JS, Aletaha D (2011) Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology (Oxford) 50:381–388

    Article  Google Scholar 

  28. Dahlström Ö, Timpka T, Hass U, Skogh T, Thyberg I (2008) A simple model for heuristic modelling of expert knowledge in chronic disease: identification of prognostic subgroups in rheumatology. Stud Health Technol Inform 136:157–162

    PubMed  Google Scholar 

  29. Scott DL (1993) A simple index to assess disease activity in rheumatoid arthritis. J Rheumatol 20:582–584

    PubMed  CAS  Google Scholar 

  30. Heiberg T, Kvien TK, Mowinckel P, Aletaha D, Smolen JS, Hagen KB (2008) Identification of disease activity and health status cut-off points for the symptom state acceptable to patients with rheumatoid arthritis. Ann Rheum Dis 67:967–971

    Article  PubMed  CAS  Google Scholar 

  31. Ekdahl C, Eberhardt K, Andersson SI, Svensson B (1988) Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol 17:263–271

    Article  PubMed  CAS  Google Scholar 

  32. Young A (2009) What have we learnt from early rheumatoid arthritis cohorts? Best Pract Res Clin Rheumatol 23:3–12

    Article  PubMed  Google Scholar 

  33. Thyberg I, Hass UA, Nordenskiöld U, Gerdle B, Skogh T (2005) Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: the Swedish TIRA-project. Arthritis Rheum 53:886–896

    Article  PubMed  Google Scholar 

  34. Puolakka K, Kautiainen H, Mottonen T, Hannonen P, Korpela M, Hakala M, Luukkainen R, Vuori K, Blåfield H, Leirisalo-Repi M (2009) Use of the Stanford Health Assessment Questionnaire in estimation of long-term productivity costs in patients with recent-onset rheumatoid arthritis. Scand J Rheumatol 38:96–103

    Article  PubMed  CAS  Google Scholar 

  35. Toussirot E (2010) Predictive factors for disability as evaluated by the health assessment questionnaire in rheumatoid arthritis: a literature review. Inflamm Allergy Drug Targets 9:51–59

    PubMed  CAS  Google Scholar 

  36. Kalyoncu U, Dougados M, Daurès J-P, Gossec L (2009) Reporting of patient-reported outcomes in recent trials in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 68:183–190

    Article  PubMed  CAS  Google Scholar 

  37. Oude Voshar MAH, ten Klooster PM, Taal E, van de Laar MAFJ (2011) Measurement properties of physical function scales validated for use in patients with rheumatoid arthritis: a systematic review of the literature. Health Qual Life Outcome 9:99

    Article  Google Scholar 

  38. Bickenbach JE, Chatterji S, Badley EM, Ustun TB (2009) Models of disablement, universalism and the international classification of impairments, disabilities and handicaps. Soc Sci Med 48:1173–1187

    Article  Google Scholar 

  39. Ware JE, Sherbourne CD (1992) The MOS 36-items short-form health survey (SF-36). Med Care 30:473–483

    Article  PubMed  Google Scholar 

  40. Sullivan M, Karlsson J, Ware JE (1994) SF-36 Health Survey: manual and interpretation guide. Sahlgrenska University Hospital, Göteborg, In Swedish

    Google Scholar 

  41. Eriksson E, Nordlund (2002) Health and health-related quality of life as measured with the EQ-5D and the SF-36 in south-east Sweden: results from two population surveys. Folkhälsovetenskapligt centrum, Linköping, In Swedish

    Google Scholar 

  42. West E, Wållberg Jonsson S (2005) Health-related quality of life in rheumatoid arthritis in Northern Sweden: a comparison between patients with early RA, patients with medium-term disease and controls, using SF-36. Clin Rheumatol 24:117–122

    Article  PubMed  Google Scholar 

  43. Cieza A, Brockow T, Ewert T, Amman E, Kollerits B, Chatterji S, Ustun TB, Stucki G (2002) Linking health-status measurements to the international classification of functioning, disability and health. J Rehabil Med 32:205–210

    Article  Google Scholar 

  44. Veehof MM, Ten Klooster PM, Taal E, van Riel PL, van de Laar MA (2008) Comparison of internal and external responsiveness of the generic Medical Outcome Study Short Form-36 (SF-36) with disease-specific measures in rheumatoid arthritis. J Rheumatol 35:610–617

    PubMed  Google Scholar 

  45. Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou JF, Meyer O, Sany J, Dubois A, Daurès JP, Dougados M (2003) Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 30:2344–2349

    PubMed  Google Scholar 

  46. Macedo A, Oakley S, Panayi G, Kirkham B (2009) Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Rheum 61:1522–1530

    Article  PubMed  Google Scholar 

  47. Söderlin MK, Lindroth Y, Jacobsson LTH (2010) A more active treatment has profound effects on the health status of rheumatoid arthritis (RA) patients: results from a population-based RA register in Malmö, Sweden, 1997–2005. Scand J Rheumatol 39:206–211

    Article  PubMed  Google Scholar 

  48. Dahlström Ö, Thyberg I, Hass U, Skogh T, Timpka T (2006) Designing a decision support system for existing clinical organizational structures: considerations from a rheumatology clinic. J Med Syst 30:325–331

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported by the Medical Research Council of Southeast Sweden (FORSS), the Swedish Rheumatism Association and the County Council of Östergötland.

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Authors and Affiliations

  1. AIR/Rheumatology Unit, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

    Ingrid Thyberg

  2. The Swedish Institute for Disability Research, Linköping and Örebro University, Linköping, Sweden

    Ö. Dahlström, P. Arvidsson & M. Thyberg

  3. Linnaeus Centre HEAD, Linköping University, Linköping, Sweden

    Ö. Dahlström

  4. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden

    Ö. Dahlström

  5. Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden

    M. Björk

  6. Rehabilitation Medicine, Department of Medical and Health Sciences, Linköping University, and Pain and Rehabilitation Centre, University Hospital, Linköping, Sweden

    M. Thyberg

  7. Department of Rheumatology, Linköping University Hospital, 581 85, Linköping, Sweden

    Ingrid Thyberg

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  1. Ingrid Thyberg
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  2. Ö. Dahlström
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Correspondence to Ingrid Thyberg.

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Thyberg, I., Dahlström, Ö., Björk, M. et al. Potential of the HAQ score as clinical indicator suggesting comprehensive multidisciplinary assessments: the Swedish TIRA cohort 8 years after diagnosis of RA. Clin Rheumatol 31, 775–783 (2012). https://doi.org/10.1007/s10067-012-1937-0

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  • DOI: https://doi.org/10.1007/s10067-012-1937-0

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