Background Treat to Target (T2T) is the main strategy for the treatment of rheumatoid arthritis (RA). We need to control disease activity in order to sustain ADL in optimal status and minimize joint destructive risk for each patient.
Objectives To clarify how disease activity and joint destruction affect on Health Assessment Questionnaire (HAQ), the relationship between Simplified Disease Activity Index (SDAI), HAQ, and disease progression is investigated.
Methods For every RA patients attending to our institute, we have been calculating SDAI and HAQ since August 2010. Our treatment protocol for RA was programmed according to T2T recommendation. Patients have counted 351 until October 2011, and total measured times was 2857 times. After excluding patients who were treated with biologic agents and patients who attended less than five times, 202 patients has been counted throughout one year follow up. Steinbrocker’s stage classification based on X-ray pictures has been made every year. According to the criteria, patients were classified as 86 patients of Stage1, 54 of Stage2, 34 of Stage3, and 28 of Stage4. Average SDAI, probability of SDAI remission and low disease activity (LDA) (C-ratio), relationship between SDAI and HAQ, were evaluated and compared for each stage group statistically. HAQ obtained at the time of SDAI remission (B-HAQ) for each patient is also compared for each group. Maximum and minimum SDAI and HAQ at the time for each patient were picked up for the comparison of HAQ difference between active and controlled phase of the RA. The average HAQ value (A-HAQ) for each group was also compared statistically. Linear regression among HAQ, SDAI, and Stage is also evaluated statistically. At last, average HAQ at the time of remission, and at the time of no remission (D-HAQ) are compared for each group statistically.
Results In 2323 times of measurement, there were 932 times of Stage1, 605 of Stage2, 398 of Stage3, and 380 of Stage4. No patient whose stage had changed in the followed term has shown. Average SDAI of smaller stage showed significant difference than any of other larger stage (p<0.0001). Every four groups except Stage4 showed significant close relationship between SDAI and HAQ (p<0.0001). B-HAQ demonstrated significant tendency. As stage progress, B-HAQ becomes significantly greater (p<0.0001). C-ratio demonstrated significantly smaller as stage progress (p<0.0001). A-HAQ demonstrated significant tendency. As stage progress, A-HAQ becomes significantly greater (p<0.0001). Linear regression demonstrated significantly (p<0.0001). All stage group but Stage4 demonstrated significant smaller D-HAQ (p<0.0001).
Conclusions These results supported T2T strategy. As stage progress, disease activity control becomes difficult, and ADL limitation increases. Disease control is easier in early stage. And as disease activity is controlled tightly, ADL remission becomes more sustainable. ADL is influenced both by disease activity and by stage progression. However, effect of activity control is getting smaller as stage progress. As stage progress, HAQ management becomes difficult as well as activity management. In Stage4, even patients can attain SDAI remission, HAQ showed no improvement. Therefore we should control RA activity tightly and sustain clinical remission status as tightly as possible in early stage.
Disclosure of Interest None Declared
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