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Early functional disability predicts both all cause and cardiovascular mortality in people with inflammatory polyarthritis: results from the Norfolk Arthritis Register
  1. Tracey M Farragher (tracey.farragher{at}manchester.ac.uk)
  1. The University of Manchester, United Kingdom
    1. Mark Lunt (mark.lunt{at}manchester.ac.uk)
    1. The University of Manchester, United Kingdom
      1. Diane K Bunn (diane.bunn{at}manchester.ac.uk)
      1. Norfolk and Norwich University Hospital, United Kingdom
        1. Alan J Silman (alan.silman{at}manchester.ac.uk)
        1. The University of Manchester, United Kingdom
          1. Deborah P M Symmons (deborah.symmons{at}manchester.ac.uk)
          1. The University of Manchester, United Kingdom

            Abstract

            Objective:To investigate the predictive value of early functional disability in patients with inflammatory polyarthritis (IP), for all cause and cardiovascular (CVD) mortality.

            Methods:1,010 subjects with new onset IP from the Norfolk Arthritis Register were studied. All were seen at baseline and one-year. Health Assessment Questionnaire (HAQ) scores were obtained at both time- points. Vital status at 10 years from registration was established via central records. Mortality rates (all cause and CVD) per 1,000 person years were calculated by HAQ stratum (HAQ scores <1, 1 to 2, ≥2). The predictive value of HAQ (per unit increase) at the two time-points, adjusted for age at symptom onset, gender, and other factors found to predict mortality, was assessed using Cox regression models. The analysis was repeated for those who satisfied the 1987 ACR criteria for rheumatoid arthritis (RA) by 5 years.

            Results:By 10 years, 171 (16.9%) subjects had died. 89 deaths (52%) were attributed to CVD. Mortality rates were greatest in the highest HAQ group at both time-points. Following adjustment for other predictors, HAQ score at year 1 remained a significant predictor of all cause mortality (HR 1.46; 95% CI 1.15, 1.85) and CVD mortality (HR 1.49; 95% CI 1.12, 1.97). The predictive value of HAQ at year 1 was similar in the RA subgroup.

            Conclusions:Our data show that; at one year of follow-up, HAQ score is an important independent predictor of subsequent all cause and CVD mortality in people with IP and RA. Baseline HAQ scores are of less value.

            • cardiovascular mortality
            • functional disability
            • inflammatory polyarthritis
            • outcome
            • premature mortality

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