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Health Assessment Questionnaire at One Year Predicts All-Cause Mortality in Patients With Early Rheumatoid Arthritis.

Safoora Fatima1, O Schieir2, M F Valois3

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Higher disability, measured by the Health Assessment Questionnaire (HAQ) score, at one year after diagnosis is linked to increased mortality risk in early rheumatoid arthritis (RA) patients. This highlights the importance of monitoring functional status in early RA management.

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Area of Science:

  • Rheumatology
  • Clinical Epidemiology
  • Public Health

Background:

  • Established rheumatoid arthritis (RA) shows associations between high self-reported disability (Health Assessment Questionnaire [HAQ] score) and increased hospitalizations and mortality.
  • The prognostic significance of disability in early RA, specifically concerning mortality risk, remains largely uncharacterized.
  • Early identification of mortality predictors in RA is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

  • To investigate the association between self-reported disability, quantified by HAQ scores at baseline and one year, and all-cause mortality in patients with early RA.
  • To determine if HAQ scores in the first year of RA diagnosis are independent predictors of long-term mortality.
  • To explore the relationship between disease activity (DAS28) and mortality in early RA.

Main Methods:

  • A cohort study of 1,724 patients with early RA (symptom duration <1 year) from the Canadian Early Arthritis Cohort was analyzed.
  • Patients initiated disease-modifying antirheumatic drugs (DMARDs) and had HAQ data at baseline and 1 year.
  • Discrete-time proportional hazards models were employed to assess associations of baseline and 1-year HAQ scores with all-cause mortality over a 10-year follow-up period, with adjustments for confounders.

Main Results:

  • Over 10 years, 62 deaths (3.6%) occurred. Deceased patients exhibited significantly higher HAQ scores at both baseline (1.2 ± 0.7) and 1 year (0.9 ± 0.7) compared to survivors (1.0 ± 0.7 and 0.5 ± 0.6, respectively).
  • Higher Disease Activity Score in 28 joints (DAS28) was also observed in deceased patients at baseline (5.4 ± 1.3) and 1 year (3.6 ± 1.4) versus survivors (4.9 ± 1.4 and 2.8 ± 1.4, respectively).
  • While baseline HAQ score showed an unadjusted association with mortality (HR 1.46), this significance was lost after multivariable adjustment (aHR 1.25). In contrast, a higher HAQ score at 1 year remained a significant predictor of mortality even after adjustment (aHR 1.75).

Conclusions:

  • Higher self-reported disability (HAQ score) and disease activity (DAS28) at one year post-diagnosis are significantly associated with increased all-cause mortality in early RA.
  • The HAQ score at one year appears to be a more robust predictor of mortality in early RA than the baseline HAQ score, even after accounting for other risk factors.
  • These findings underscore the importance of functional status assessment and management in the first year of RA to potentially mitigate long-term mortality risk.