Background Health Assessment Questionnaire Disability Index (HAQ-DI) is the most important index in treatment for rheumatoid arthritis (RA) patient. HAQ-DI expresses patient's disability in daily life (ADL), and this is influenced by disease activity (ACT-HAQ) and joint structural damage (DAM-HAQ), and aging when patient gets older in senectitude (AGE-HAQ) (1–3). One more factor that possibly makes influence on HAQ-DI is patient's pain. However, this problem is not discussed at all.
Objectives We have investigate patient's pain and its effect on HAQ-DI in our clinical data in order to evaluate whether pain influences on HAQ-DI, and to make assessment existence of pain related HAQ-DI (PAIN-HAQ)
Methods RA patients who have been treated continuously for more than five years, who had visited later than October 31th, 2016, were picked up in this study. Patients average 28-joints disease activity score with C-reactive protein (DAS28-CRP), modified HAQ (mHAQ), Sharp/van der Heijde Score (SvdHS), age, and pain score calculated by visual analogue scale (PS-VAS) were calculated in fifth treatment year. Average values of these parameters have been calculated. Relationships among these factors have been investigated statistically using multiple linear regression analysis (MLR). After evaluation of relationship of each pairs of these factors, the relationship between HAQ-DI and the other factors had been evaluated from modified data of these patients in minimize the effect of parameters other than PS-VAS and data that minimized effectiveness of PS-VAS with MLR.
Results 382 patients had been picked up. Their sex distribution was 87 for male and 295 for female, and their average values and standard deviations of age, DAS28-CRP, HAQ-DI, SvdHS, and PS-VAS were 68.99 and 13.47, 1.91 and 0.54, 0.43 and 0.55, 54.97 and 67.30, and 22.96 and 17.85, respectively. HAQ-DI demonstrated significant regression with all of DAS28-CRP, SvdH, age, and PS-VAS (<0.01). DAS28-CRP demonstrated positive correlation with PS-VAS, HAQ-DI, and SvdHS, but negatively correlated significantly with age (<0.01). PS-VAS demonstrated positive correlation with HAQ-DI and DAS28-CRP, but negatively correlated with SvdHS significantly (<0.01), while no significant correlation demonstrated with age. SvdHS demonstrated positive correlation with DAS28-CRP and HAQ-DI, but negative correlation with PS-VAS significantly (<0.01), while no significant correlation demonstrated with SvdHS. Age demonstrated positive correlation with HAQ-DI, but negatively correlated with DAS28-CRP (<0.01), while no significant correlation demonstrated with PS-VAS and SvdHS (Figure 1).
After minimizing the data effectiveness of DAS28-CRP, Age, and SvdHS on HAQ-DI, HAQ-DI demonstrated significant regression only with PS-VAS. When the effectiveness of PS-VAS was minimized, HAQ-DI demonstrated significant regression with parameters other than PS-VAS. Threshold of PS-VAS was 15mm.
Conclusions These results suggested that HAQ-DI is influenced PS-VAS when it is no less than 15mm. Therefore, we conclude that HAQ-DI consists with PAIN-HAQ in adding with ACT-HAQ, DAM-HAQ, and AGE-HAQ.
Smolen JS, et al. Ann Rheum Dis 2010;69:1058–1064.
Vita AJ, et al. N Engl J Med 1998; 338:1035–1041.
Yoshii I, et al. Arthritis Rheumatol. 2015; 67 (suppl 10).
Disclosure of Interest None declared