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Measuring function in rheumatoid arthritis: Identifying reversible and irreversible components.

Daniel Aletaha1, Josef Smolen, Michael M Ward

  • 1National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA. daniel.aletaha@meduniwien.ac.at

Arthritis and Rheumatism
|September 2, 2006
PubMed
Summary

In rheumatoid arthritis (RA), functional limitations have both active disease and chronic irreversible components. The Health Assessment Questionnaire (HAQ) disability index can help differentiate these, informing treatment and analysis.

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Area of Science:

  • Rheumatology
  • Clinical Trials
  • Health Outcomes

Background:

  • Physical function measurement in rheumatoid arthritis (RA) often fails to distinguish between active disease effects and chronic, irreversible impairment.
  • The Health Assessment Questionnaire (HAQ) disability index is a common measure of function in RA, but its interpretation requires understanding the source of limitations.

Purpose of the Study:

  • To differentiate the reversible (active disease) and irreversible (chronic damage) components of functional limitation in RA using the HAQ disability index.
  • To assess how RA duration and radiographic severity influence the reversible and irreversible components of functional limitation.

Main Methods:

  • Secondary analysis of data from 2,763 patients across 6 RA clinical trials.
  • Identification of patients achieving clinical remission based on a simplified disease activity index.

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  • Comparison of HAQ scores at trial entry (total impairment) with HAQ scores at remission (irreversible impairment) to determine the reversible component.

    • Main Results:

    • In patients achieving remission (n=295), HAQ scores increased with RA duration, indicating greater irreversible impairment.
    • The reversibility of HAQ scores significantly decreased with longer RA duration (P < 0.001).
    • Similar trends were observed when patients were subgrouped by radiographic severity.

    Conclusions:

    • Functional limitations in RA arise from distinct reversible and irreversible components.
    • Considering these components is crucial for accurate interpretation of functional measures, prediction models, and cost-effectiveness analyses in RA management.