The minimum clinically important change or difference in the 15D score representing overall HRQoL on a 0-1 scale is 0.015. Differences between and within hospitals were tested by independent and paired samples t-tests and linear regression with some background variables standardized. Results: At baseline, mean 15D score was in KUH (0.752) statistically significantly (p< 0.001) and clinically importantly lower than in VCH (0.831) or HUH (0.830). The mean six-month score was 0.858 in KUH, compared to 0.860 and 0.875 in VCH and HUH, respectively. With gender, age and baseline 15D score standardized, the mean six-month scores were 0.846, 0.879 and 0.877 in KUH, VCH and HUH, respectively and the differences between KUH and both other hospitals became statistically significant (p< 0.001) and clinically important. A clinically important HRQoL improvement was experienced by 85.8, 59.1 and 64.0% and a clinically important deterioration by 6.8, 25.3 and 22.1% in KUH, VCH and HUH, respectively. ConClusions: Treatment indication and effectiveness in terms of HRQoL, i.e., 15D score change and percentage of patients experiencing a clinically important improvement or deterioration, varied between hospitals. HRQoL measurements can be used to compare effectiveness of treatment between hospitals but for fair comparisons standardization of relevant baseline demographic and clinical parameters of patients is needed.
Background:Patients with psoriatic arthritis (PsA) experience substantial functional impairment, which impacts on health-related quality of life.1Evidence from randomized clinical trials (RCTs) suggests better patient-reported functional outcomes when lower disease activity is achieved.2,3,4Objectives:To evaluate the impact of achieving DAPSA remission (REM) or low disease activity (LDA) on long term function measured by HAQ-DI. To verify predictors of achieving a minimum clinically important difference (MCID) in HAQ-DI (≤ -0.35).Methods:This is a longitudinal analysis of a real-life retrospective cohort. Inclusion criteria were adult patients fulfilling CASPAR criteria for PsA with at least 4 years of follow-up in the PsA Clinic. Demographic and clinical data were extracted from electronic medical records. Comparison of HAQ-DI variation between patients with DAPSA REM/LDA and those with moderate/high disease activity was performed using generalized estimating equation (GEE), adjusted by Bonferroni test. Correlation between HAQ-DI and DAPSA was analyzed by Spearman correlation method. A multivariate hierarchical regression model was applied in order to evaluate predictors of achieving a MCID in HAQ-DI scores.Results:Seventy-three patients were included in the analysis, of which 58.9% were female, with a median (25/75th) of 8 (3-15) years since PsA diagnosis and a mean follow up time of 6.2±1.2 years. In total, 37% of patients (N=27) presented a MCID in HAQ-DI during the follow-up. Function measured by HAQ-DI was determined by PsA disease activity measured by DAPSA (interaction test: p <0.0001) (Figure 1). A moderate and statistically significant correlation between ΔDAPSA and ΔHAQ-DI was observed (rs= 0.60; p<0.001) (Figure 2), demonstrating that a decrease in PsA disease activity was associated to improvement in function. Only patients in DAPSA REM demonstrated a constant declining in HAQ-DI scores during the 6 years of follow-up (Figure 1). White ethnicity and older age at baseline were predictors for not achieving MCID in HAQ-DI (RR 0.33 95% CI 0.16-0.67, p=0.002 and RR 0.96 95% CI 0.93-0.98, p<0.0001, respectively), while higher scores of HAQ-DI at baseline were predictors of achieving a MCID (RR 1.71 95%CI 1.12-2.60, p=0.013).Figure 1.Variation in HAQ-DI according to PsA disease activity measured by DAPSAFigure 2.Correlation between changes in PsA disease activity (ΔDAPSA) and changes in functional indices (ΔHAQ-DI) over three years of follow-upConclusion:In PsA, patients who maintained DAPSA REM/LDA over time had better long term functional outcomes. Higher HAQ-DI scores at baseline, non-white ethnicity and younger age were predictors for achieving a clinical significant improvement in HAQ-DI.References:[1]Mease P et al. Semin Arthritis Rheum. 2018 Dec;48(3):436-448.[2]Coates, LC et al. The Lancet. 2015 Dec; 386, 19-26.[3]Aletaha D et al. Ann Rheum Dis. 2017;76(2):418-421.[4]Kavanaugh A et al. Annals rheum Dis 2014; 73: 1689-94.Median HAQ-DIFollow-up in yearsDisclosure of Interests:Larissa Vargas Cruz: None declared, Júlia Boechat Farani: None declared, Júlia Rabello Costa: None declared, Franciele Menegat: None declared, João Victor Andrade Águas: None declared, Bruna Ruschel: None declared, Andrese Aline Gasparin: None declared, Claiton Brenol: None declared, Charles Kohem Grant/research support from: This work was sponsored by the regional society of rheumatology (Sociedade de Reumatologia do Rio Grande do Sul)., Penelope Palominos Grant/research support from: This work was sponsored by the regional society of rheumatology (Sociedade de Reumatologia do Rio Grande do Sul).
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