Background People with rheumatoid arthritis (RA) and other chronic diseases adjust their lifestyle to accommodate symptoms and limitations.
Objectives The aim of the current analysis was to assess the utilization of aids/devices or help over time and to determine whether development of self-management behavior is responsible for HAQ improvement in RA patients on anti-TNF treatment in a real-world clinical practice setting.
Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. Data were used from RA patients treated with infliximab (IFX) between 2002-2014 or with golimumab (GLM) between 2010-2014. The correlation between the standard HAQ disability index (HAQ-DI) and the alternative disability index (HAQ-ADI), incorporating or not the use of aids/devices/help, respectively, was assessed with the Pearson's correlation coefficient. Changes in HAQ-DI, HAQ-ADI, the individual HAQ domain scores, or the difference between HAQ-DI and HAQ-ADI over time, were assessed with general linear models. The slope of HAQ-DI and HAQ-ADI improvement in each patient was assessed with the paired-samples t-test.
Results 1030 RA patients were included with a mean (SD) age of 56.1 (13.5) years and time since diagnosis of 8.5 (9.1) years. Mean (SD) DAS28, CDAI, HAQ-DI and HAQ-ADI scores at baseline were 5.6 (1.5), 34.3 (16.6), 1.59 (0.71), 1.47 (0.73), respectively.
At baseline, highest HAQ domain scores included “Activities”, “Reach”, “Hygiene”, and “Grip”. The use of aids/devices/help was highest for these activities (49.2%, 47.5%, 38.0%, 73.1% of patients, respectively), with females requesting significantly more aids/devices/help than males. Treatment for 60 months resulted in statistically significant and clinically meaningful improvements in HAQ-DI and HAQ-ADI, and in significantly lower utilization of aids/devices/help.
A statistically significant difference (P=0.001) was observed in the slope of HAQ-DI (Δ=-0.034/month) and HAQ-ADI (Δ=-0.038/month) improvement over time which could be attributed to the differential rate of use of aids/devices/help over time resulting in the inflation of HAQ-DI. The duration of follow-up was significantly (P<0.001) associated with a greater difference between HAQ-DI and HAQ-ADI changing from 0.12 at baseline to 0.18 at 60 months.
Conclusions Our results have shown that problems with “Activities”, “Reaching”, “Hygiene”, and “Gripping” represent primary challenges in RA. Anti-TNF treatment resulted in significant improvements in all HAQ domains. Significant differences were observed over time, however, between HAQ-DI and HAQ-ADI suggesting that RA patients may also adjust their lifestyle to accommodate their symptoms. These findings highlight the importance of educational programs focused on self-management behaviors in RA.
Disclosure of Interest D. Sholter Consultant for: Janssen, W. Olszynski Consultant for: Janssen, P. Baer Consultant for: Janssen, M. Sheriff Consultant for: Janssen, S. Dixit Consultant for: Janssen, A. Chow: None declared, B. Haraoui Consultant for: Janssen, D. Choquette Consultant for: Janssen, J. Kelsall Consultant for: Janssen, J. Sampalis: None declared, E. Rampakakis: None declared, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, A. Lehman Employee of: Janssen