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Disease and disability in early rheumatoid arthritis: A 3-year follow-up of women and men in the Swedish TIRA project
Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rheumatoid arthritis (RA) is a chronic inflammatory disease, which often leads to disability. This study is based on three years’ follow-up data generated by patients included during 27 months 1996-1998 in a Swedish multi-centre project named ‘early interventions in rheumatoid arthritis’ (TIRA). Disease activity, disability and health-related quality of life (HRQL) were assessed by clinical and laboratory analyses, and self-reported estimations. The course during three years and relations between clinical/laboratory assessments versus HRQL were studied separately in women and men. The relation between grip force and self-reported activity limitations was analysed, and finally the use and effects of assistive devices were evaluated separately for women and men.

Clinical/laboratory assessments and self-reported HRQL were substantially affected at the time for diagnosis, but the relations between clinical/laboratory assessments and self-reported HRQL were weak. Among the studied clinical/laboratory variables used here grip force, walking speed, and possibly physician’s global assessment of disease activity showed most stable relationships with the HRQL. However, the time course of clinical/laboratory and selfreported HRQL measurements followed similar patterns. Thus, most variables had improved considerably at the 3- and 6-months’ follow-ups and then remained stable but still affected over three years. An exception was the SF-36 scale ‘general health’, which was reduced to the same extent during the whole study period.

As judged by the ‘Health Assessment Questionnaire’ (HAQ) and ‘Evaluation of Daily Activities Questionnaire’ (EDAQ), activity limitations were more pronounced in women than in men. By contrast, as reflected by ‘Signals of Functional Impairment’ (SOFI), men had slightly more affected function of the hands and upper extremities. Women with RA had about half of the grip force compared to male patients, which is in accordance with the differences between healthy women and men. At diagnosis, the grip force was reduced to about 30% in RA patients compared to healthy referents of the same sex. Already three months later, it improved but was still reduced to about 50% of healthy referents.

Further analyses revealed that HAQ and EDAQ were strongly related to grip force independently of sex. Grip force below 114 N was found to be associated with substantial activity limitation in women as well as in men. Assistive devices (ADs) were more frequently used by women (78%) than men (54%), and were found to reduce activity limitations. The subgroups of women and men using ADs were comparable regarding disease activity and disability, and were generally more affected regarding activity limitations, compared to the subgroups that did not use ADs. Within the subgroups of patients using ADs, women and men had equivalent HAQ status and ADs were reported to reduce activity limitations in both women and men with recent-onset RA.

The weak relation between clinical/laboratory assessments and self-reported HRQL supports the results by others. By means of HAQ, more pronounced activity limitations have been reported previously in women with RA, compared to male patients. In the present study, similar differences were recorded by EDAQ. Further analyses showed that reduced grip force was closely related to activity limitations independently of sex. This offers a new explanation to poor female outcome recorded by HAQ.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2005. , 53 p.
Series
Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 16Linköping University Medical Dissertations, ISSN 0345-0082 ; 906
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16676ISBN: 91-85299-16-2 (print)OAI: oai:DiVA.org:liu-16676DiVA: diva2:159777
Public defence
2005-09-02, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2015-08-31Bibliographically approved
List of papers
1. Recent-onset rheumatoid arthritis: A 1-year observational study of correlations between health‐related quality of life and clinical/laboratory data
Open this publication in new window or tab >>Recent-onset rheumatoid arthritis: A 1-year observational study of correlations between health‐related quality of life and clinical/laboratory data
2005 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 37, no 3, 159-165 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To analyse correlations within and between clinical/laboratory assessments and health-related quality of life variables for recent-onset rheumatoid arthritis at the time of diagnosis and 12 months later.

Methods: A total of 297 patients with recent-onset (?12 months) rheumatoid arthritis were included at diagnosis and followed up for 12 months. Clinical/laboratory assessment was performed by erythrocyte sedimentation rate, C-reactive protein, 28-joint count of tender/swollen joints, physician's global assessment, grip force, grip ability, functional impairment and walking speed. The self-reported health-related quality of life included symptoms (pain, morning stiffness), patients estimated general health, Health Assessment Questionnaire and SF-36.

Results: All tested variables improved within 6 months of diagnosis and then remained stable but still affected at the 12-month follow-up. Multivariate correlations between clinical/laboratory variables and health-related quality of life were weak. At inclusion, clinical/laboratory assessments explained 18% of health-related quality of life at the same time-point and predicted 7% of the variation in health-related quality of life after 12 months.

Conclusion: The time-course followed similar patterns for most variables, but only a small part of the variation in health-related quality of life was explained or predicted by the clinical/laboratory variables. This implies that health-related quality of life adds important information to clinical/laboratory assessments in clinical practice and should be considered in goal setting together with clinical/laboratory assessment in order to optimize healthcare and outcome.

Place, publisher, year, edition, pages
Taylor & Francis, 2005
Keyword
Outcome, early rheumatoid arthritis, health‐related quality of life, HAQ, SF‐36, grip force, walking speed
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16666 (URN)10.1080/16501970410023344 (DOI)
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2015-08-31Bibliographically approved
2. A Survey of the use and effect of assistive devices in patients with early rheumatoid arthritis: A two-year followup of women and men
Open this publication in new window or tab >>A Survey of the use and effect of assistive devices in patients with early rheumatoid arthritis: A two-year followup of women and men
2004 (English)In: Arthritis Care and Research, ISSN 0893-7524, Vol. 51, no 3, 413-421 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To identify activity limitation in early rheumatoid arthritis (RA) to detect patients needing assistive devices. To evaluate the effects of assistive devices.

Methods: A multicenter cohort of 284 early RA patients was examined using the Evaluation of Daily Activity Questionnaire 12 and 24 months after diagnosis.

Results: The extent of activity limitation was stable over time for both women and men. Most limitations concerned eating and drinking. Women reported more difficulties than did men. The use of assistive devices was related to subgroups with severe disease and more disability. Use of assistive devices reduced difficulties significantly. For both women and men, assistive devices were mostly used in activities related to eating and drinking.

Conclusion: Already 1 year after diagnosis, RA patients reported activity limitation that remained stable over time. Use of assistive devices was related to more severe disease and more pronounced disability. Use of devices reduced difficulties significantly.

Place, publisher, year, edition, pages
Wiley InterScience, 2004
Keyword
Assistive devices, Early rheumatoid arthritis, Activity limitation, Sex
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16668 (URN)10.1002/art.20410 (DOI)
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2015-08-31Bibliographically approved
3. Hand Function and Activity Limitation According to Health Assessment Questionnaire in Patients with Rheumatoid Arthritis and Healthy Referents: 5-Year Followup of Predictors of Activity Limitation (The Swedish TIRA Project)
Open this publication in new window or tab >>Hand Function and Activity Limitation According to Health Assessment Questionnaire in Patients with Rheumatoid Arthritis and Healthy Referents: 5-Year Followup of Predictors of Activity Limitation (The Swedish TIRA Project)
2007 (English)In: Journal of Rheumatology, ISSN 0315-162X, Vol. 34, no 2, 296-302 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-7157 (URN)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2009-02-25Bibliographically approved
4. Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: The Swedish TIRA project
Open this publication in new window or tab >>Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: The Swedish TIRA project
Show others...
2005 (English)In: Arthritis Care and Research, ISSN 0893-7524, Vol. 53, no 6, 886-896 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate activity limitations 3 years after diagnosis of early rheumatoid arthritis (RA) in relation to grip force and sex.

Methods: A total of 217 patients, 153 women and 64 men, with recent-onset RA were included. Activity limitations were reported using the Health Assessment Questionnaire (HAQ) and the Evaluation of Daily Activities Questionnaire (EDAQ). The relationships between activity limitations versus grip force (measured by the Grippit), walking speed, functional impairment, grip ability, pain, plasma C-reactive protein, the 28-joint disease activity score and its components, the physician's global assessment of disease activity, and sex were analyzed by partial least squares (PLS).

Results: Women had significantly lower grip force and more activity limitations (HAQ and EDAQ) than men. The PLS analyses demonstrated that grip force was the strongest regressor of activity limitation, closely followed by walking speed. However, within subgroups based on grip force (group 1 = grip force <114 N, group 2 = 116-206 N, group 3 = 214-321 N, group 4 = grip force >328 N) and including sexes, women and men had corresponding degrees of activity limitation as reported by the HAQ and EDAQ.

Conclusion: Our results indicate that the more pronounced activity limitations seen in women with RA, as compared with men, may be explained by lower grip force rather than sex.

Place, publisher, year, edition, pages
Wiley InterScience, 2005
Keyword
Activity limitation, Grip force, Health Assessment Questionnaire, Evaluation of Daily Activities Questionnaire, Rheumatoid arthritis, Sex
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16671 (URN)10.1002/art.21595 (DOI)
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2015-08-31Bibliographically approved

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