Background Activity in daily living (ADL) is one of main target to maintain patient's quality of life in rheumatoid arthritis (RA) treatment. Modified Health Assessment Questionnaire (mHAQ) is a most popular index for ADL in routine practice. mHAQ is separated according to function of extremity; namely the first four categories are reflections of upper extremities (mHAQ-UE), while the latter are of lower extremities (mHAQ-LE). If function of each extremity is separately disabled, it should be reflected on each part of mHAQ.
Objectives mHAQ was separately investigated in order to evaluate characteristics of each part of mHAQ.
Methods 964 RA patients since January 2010 had been treated. In these, patients who have been treated consecutively for more than five years at December 2016 were recruited in this study. Patient who had been operated musculoskeletal surgery was eliminated. mHAQ, mHAQ-UE and mHAQ-LE, and 28-joint disease activity index with C-reactive protein (DAS28-CRP) were measured every time since first consult. Average value of these parameters including Sharp/van der Heijde Score (SvdHS) were calculated annually. Relationship between each of mHAQ and parameters for each year were evaluated used with multiple linear regression analysis.
Predominant extremity in mHAQ was evaluated as in what upper extremity predominant (G-UE), lower extremity predominant (G-LE), same weight (G-EV), and both of them were zero (G-Z). Changes of the evaluation from first to the last period were evaluated year by year.
Results One hundred and two male and three hundred and thirty-three female, totally four hundred and thirty five patients were picked up. Their average value of age, SvdHS, DAS28-CRP, mHAQ, mHAQ-UE, and mHAQ-LE were 64.65, 52.1, 2.96, 0.439, 0.386 and 0.491 at first consult, and 71.05, 52.1, 1.72, 0.425, 0.344, and 0.505 at last time follow up, respectively. Both of mHAQ-UE and mHAQ-LE have demonstrated significant regression with both age and SvdHS throughout treatment, while not significant with DAS28-CRP, however, mHAQ-UE correlated with tenderness joint except of knee, and mHAQ-LE have correlated with swelling of the knee joint significantly.
G-UE had counted for 85 patients, G-LE for 136, G-EV for 49, and G-Z for 165 at first consult. Once evaluation had changed, then have continued to the last in all patients. G-UE resulted in G-UE for 83, while G-LE for 2 at last. G-LE resulted in G-LE for 133, G-Z for 2, and G-EV for 1. G-EV resulted in G-LE for24, G-UE for 7, and G-EV for 18. G-Z resulted in G-Z for 137, G-LE for 19, G-UE for 4, and G-EV for 5. G-EV to G-EV demonstrated significant higher DAS28-CRP improvement from first to the last than to G-LE, and to G-UE, and G-EV to G-LE demonstrated significant higher DAS28-CRP improvement than to G-UE, although no significant difference demonstrated for mHAQ improvement among groups. G-UE to G-LE demonstrated significant higher DAS28-CRP improvement than to G-UE, as well as G-UE to G-LE demonstrated significant higher mHAQ improvement than to G-UE.
Conclusions From these results, it is suggested that mHAQ-UE and mHAQ-LE move under common influence. However, mHAQ-UE change may be reflected by upper exrtremities joint tenderness, while mHAQ-LE can move more sensitively with knee swelling. Tight disease activity control may reduce mHAQ both of them, however, reduces more predominantly with mHAQ-UE than mHAQ-LE.
Disclosure of Interest None declared