Document Detail


Treatment and nontreatment predictors of health assessment questionnaire disability progression in rheumatoid arthritis: a longitudinal study of 18,485 patients.
MedLine Citation:
PMID:  21080449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine predictors of progression of disability in rheumatoid arthritis (RA), as measured by the Health Assessment Questionnaire disability index (HAQ), and to determine rates of progression during biologic treatment.
METHODS: We followed 18,485 RA patients for up to 11 years (mean 3.7 years) in a longitudinal study of RA outcomes. Patients were characterized as having moderate or severe RA versus less severe RA at study entry. Annualized progression rates were determined in multivariable analyses using generalized estimating equations.
RESULTS: Although all of the demographic and severity characteristics were associated with baseline differences in HAQ score, progression was only associated with age, comorbidity, initial severity, and treatment. HAQ score increased fastest in patients ages >65 years (0.031; 95% confidence interval [95% CI] 0.028, 0.034). HAQ progression was independently associated with the presence of baseline cardiovascular disease, hypertension, diabetes mellitus, and the number of comorbid conditions. Annualized progression rates were greater in patients with mild to inactive RA (0.021; 95% CI 0.019, 0.023) than in moderate to severe RA (0.003; 95% CI 0.001, 0.006). The overall progression rate during biologic treatment was 0.008 (95% CI 0.005, 0.011); for patients with moderate to severe RA, the rate was 0.001 (95% CI -0.005, 0.003).
CONCLUSION: Age and comorbidity are important predictors of the rate of loss of functional status, and have a stronger effect on HAQ progression than does biologic treatment. There is little difference in progression rates among biologics. Patients with more severe RA progress less than those with less severe RA, a possible function of regression to the mean.
Authors:
Kaleb Michaud; Gene Wallenstein; Frederick Wolfe
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, American Recovery and Reinvestment Act; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-11-15
Journal Detail:
Title:  Arthritis care & research     Volume:  63     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2012-01-30     Completed Date:  2012-03-13     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  366-72     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / diagnosis*,  drug therapy*,  epidemiology
Comorbidity
Disability Evaluation*
Disease Progression
Drug Therapy, Combination
Female
Humans
Linear Models
Longitudinal Studies
Male
Middle Aged
Predictive Value of Tests
Questionnaires*
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
1RC1AR058601-01/AR/NIAMS NIH HHS; RC1 AR058601/AR/NIAMS NIH HHS; RC1 AR058601-01/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Antirheumatic Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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