Health Assessment Questionnaire at One Year Predicts All‐Cause Mortality in Patients With Early Rheumatoid Arthritis Academic Article uri icon

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abstract

  • OBJECTIVE: Higher self-reported disability (high Health Assessment Questionnaire [HAQ] score) has been associated with hospitalizations and mortality in established rheumatoid arthritis (RA), but associations in early RA are unknown. METHODS: Patients with early RA (symptom duration <1 year) enrolled in the Canadian Early Arthritis Cohort who initiated disease-modifying antirheumatic drugs and had completed HAQ data at baseline and 1 year were included in the study. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations of baseline HAQ and HAQ at 1 year with all-cause mortality in each year of follow-up. RESULTS: A total of 1,724 patients with early RA were included. The mean age was 55 years, and 72% were women. Over 10 years, 62 deaths (3.6%) were recorded. Deceased patients had higher HAQ scores at baseline (mean ± SD 1.2 ± 0.7) and at 1 year (0.9 ± 0.7) than living patients (1.0 ± 0.7 and 0.5 ± 0.6, respectively; P < 0.001). Disease Activity Score in 28 joints (DAS28) was higher in deceased versus living patients at baseline (mean ± SD 5.4 ± 1.3 versus 4.9 ± 1.4) and at 1 year (mean ± SD 3.6 ± 1.4 versus 2.8 ± 1.4) (P < 0.001). Older age, male sex, lower education level, smoking, more comorbidities, higher baseline DAS28, and glucocorticoid use were associated with mortality. Contrary to HAQ score at baseline, the association between all-cause mortality and HAQ score at 1 year remained significant even after adjustment for confounders. For baseline HAQ score, the unadjusted hazard ratio (HR) was 1.46 (95% confidence interval [95% CI] 1.02-2.09), and the adjusted HR was 1.25 (95% CI 0.81-1.94). For HAQ score at 1 year, the unadjusted HR was 2.58 (95% CI 1.78-3.72), and the adjusted HR was 1.75 (95% CI 1.10-2.77). CONCLUSION: Our findings indicate that higher HAQ score and DAS28 at 1 year are significantly associated with all-cause mortality in a large early RA cohort.

authors

  • Fatima, Safoora
  • Schieir, O
  • Valois, MF
  • Bartlett, SJ
  • Bessette, L
  • Boire, G
  • Hazlewood, G
  • Hitchon, C
  • Keystone, EC
  • Tin, D
  • Thorne, C
  • Bykerk, VP
  • Pope, JE
  • Baron, Murray
  • Bessette, Louis
  • Boire, Gilles
  • Bykerk, Vivian
  • Colmegna, Ines
  • Fallavollita, Sabrina
  • Haaland, Derek Allan
  • Haraoui, Paul
  • Hazlewood, Glen
  • Hitchon, Carol
  • Jamal, Shahin
  • Joshi, Raman
  • Keystone, Ed
  • Nair, Bindu
  • Panopoulos, Peter
  • Pope, Janet
  • Rubin, Laurence
  • Thorne, Carter
  • Villeneuve, Edith
  • Zummer, Michel

publication date

  • February 2021

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