Potential of the HAQ score as clinical indicator suggesting comprehensive multidisciplinary assessments: the Swedish TIRA cohort 8 years after diagnosis of RA

Abstract

This study explores the potential of the health assessment questionnaire (HAQ) score as a clinical indicator that can be used to suggest comprehensive multidisciplinary assessments, by relating it to more general aspects of disability. In a cohort of 132 patients with early RA (mean age 55, 68% women), 28 joint count Disease Activity Scores (DAS-28), HAQ, and Short Form 36 (SF-36) scores were registered at annual follow-up visits 8 years after diagnosis. The patients were tentatively sub-grouped into a high-HAQ group (HAQ ≥ 1 at the 8-year follow-up) and a low-HAQ group. The high-HAQ group, comprising 36% of the cohort, had a higher mean HAQ score at inclusion and beyond at all visits compared to the low-HAQ group, and 24% of all individual patients in the high-HAQ group had a HAQ score ≥ 1 at inclusion. Although the DAS-28 improved in both groups, patients in the high-HAQ group also had significantly more persistent disability according to the SF-36: five scales at each follow-up visit and all eight scales at the majority of the visits. Individual RA patients with HAQ ≥ 1 probably have considerable persistent disabilities according to the SF-36. The HAQ score could be used as a clinical indicator suggesting comprehensive multidisciplinary assessments of the components of disability and corresponding interventions, in addition to the established use of HAQ at group levels and in parallel with the medication strategy based on DAS-28.

Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project)

“…This study is associated with the prospective multi-centre early arthritis project with the Swedish acronym TIRA-2 [3]. The purpose of TIRA-2 was to establish routines for early diagnosis and intervention, and to collect research data.…”

“…Because the disease mechanisms are now fairly well known, today's strategy of early pharmacological treatment and new biological drugs have lead to reduced disease activity and less disability compared to previously [4,5]. However, even in early RA many patients still report disability, implying a persistent need for rehabilitative interventions and medication, and probably also improvements of clinical reasoning with respect to rehabilitation strategies [3,6,7]. In comparison with the greatly developed knowledge of biological aspects of the disease, it is necessary to learn more about patients' perspectives of disabling mechanisms in order to improve the rehabilitation part of clinical interventions.…”

“…Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability [1][2][3]. Because the disease mechanisms are now fairly well known, today's strategy of early pharmacological treatment and new biological drugs have lead to reduced disease activity and less disability compared to previously [4,5].…”

“…Though it is known that even basic daily activities are affected in today´s patients with early RA [3] and that more complex aspects, so-called valued life activities, are important for the psychological well-being of populations with long term RA [12], there is a clinical need to explore the patterns of disability in more detail in order to support the early intervention strategy of today [13]. One problem is that studies on these issues refer to quite different underlying theories and terminologies.…”

“…One problem is that studies on these issues refer to quite different underlying theories and terminologies. For example, the terminologies of the Health Assessment Questionnaire (HAQ) [3], the Valued Life Activities (VLA) instrument [12], qualitative reports on the patients' own perspectives [13] and studies relating to the International Classification of Functioning, Disability and Health (ICF) [14] differ quite a lot.…”