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Aspects of Disability in Rheumatoid Arthritis: a five-year follow-up in the Swedish TIRA project
Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-1607-187X
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents.

This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients.

For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1063
Keyword [en]
Rheumatoid arthritis (RA), disability, hand function, pain intensity, ADL, sick leave, prediction
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:liu:diva-11956ISBN: 978-91-7393-908-9 (print)OAI: oai:DiVA.org:liu-11956DiVA: diva2:18353
Public defence
2008-06-05, Berzeliussalen, Ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2015-11-19
List of papers
1. Hand function in women and men with early rheumatoid arthritis: A prospective study over three years (the Swedish TIRA project)
Open this publication in new window or tab >>Hand function in women and men with early rheumatoid arthritis: A prospective study over three years (the Swedish TIRA project)
2006 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 35, no 1, 15-19 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the course of hand function in women and men during the first 3 years after diagnosis of recent-onset rheumatoid arthritis (RA), to investigate sex differences in hand function, and to study correlations between and within hand function assessments.

Methods: A total of 276 patients (69% women) with RA of a maximal duration of 12 months were recruited to the study. Hand function was assessed by the Grip Ability Test (GAT) and Signals of Functional Impairment (SOFI). Peak and average grip force over 10 s in the right and left hand was measured by an electronic device.

Results: Hand function was affected at diagnosis, but had improved significantly at the 3-months' follow-up and then remained stable (but still affected) in both women and men. As assessed by SOFI, hand function was worse in men than in women, whereas women had significantly lower grip force. GAT, grip force, and SOFI correlated weakly. The average and peak values of grip force correlated strongly, as did the grip force in the right and the left hand.

Conclusion: Hand function was profoundly affected at diagnosis of RA, but improved significantly within 3 months and remained stable (but still affected) over 3 years. As expected, women on average had significantly lower grip force than men.

Place, publisher, year, edition, pages
Informa Healthcare, 2006
Keyword
Hand function, course, sex differences, rheumatoid arthritis, impairment, assessment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13327 (URN)10.1080/03009740510026562 (DOI)000235183300003 ()
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2015-08-31Bibliographically approved
2. 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, E-ISSN 1499-2752, Vol. 34, no 2, 296-302 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study identifies baseline predictors of future activity limitation in rheumatoid arthritis (RA). To reinforce the utility of instruments assessing functional ability/activity limitation, we used reference data from healthy referents.

Methods: This study includes 189 patients (69% women) with recent-onset RA (onset of joint swelling not more than 12 months at diagnosis) in a prospective cohort ("the Swedish TIRA project") during 27 months from 1996 through 1998. Regular followups were done for a period of 5 years, and 123 healthy persons (50% women) were recruited as referents. Hand function was assessed by the "grip ability test (GAT)" and "signals of functional impairment" (SOFI). Grip force was measured with the electronic device GrippitTM. Activity limitation was assessed with the Swedish version of the Health Assessment Questionnaire (HAQ).

Results: Throughout the study and for both sexes, GAT, grip force, SOFI-hand, and HAQ were significantly different for the patients compared to healthy referents. In the healthy referents, HAQ was mainly related to age and GAT, whereas in RA HAQ was most obviously linked to grip force. Five years after diagnosis only 8% of HAQ outcome was explained by the baseline measures: HAQ, grip force, SOFI-lower limb, sex, walking speed, and GAT.

Conclusion: Our study provides valuable reference data for several functional ability and activity limitation measures. The HAQ score was explained by different variables in healthy referents compared to patients with RA. Five years after diagnosis only 8% of HAQ outcome was explained by the variables assessed at inclusion.

Place, publisher, year, edition, pages
Toronto, Ontario, Canada: Journal of Rheumatology Publishing Co. Ltd., 2007
Keyword
Rheumatoid Arthritis, Disabilty, Longitudinal studies, Sex differences, Reference values
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13328 (URN)000244112900012 ()
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2015-08-31Bibliographically approved
3. Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis: cross sectional and five year longitudinal analyses (the Swedish TIRA project)
Open this publication in new window or tab >>Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis: cross sectional and five year longitudinal analyses (the Swedish TIRA project)
2008 (English)In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 30, no 19, 1429-1438 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: This study analyses the relationships between pain intensity and other aspects of health commonly used to assess disease activity and disability in early rheumatoid arthritis and examines whether such relationships were different between women and men.

Subjects and methods: This study included the 189 patients (69% women) with early RA (symptoms <12 months at diagnosis) still remaining in the Swedish TIRA cohort 5 years after inclusion. Disease activity and disability was assessed 3, 6, 12, 18, 24, 36, 48, and 60 months (M0-M60) after inclusion by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), number of swollen and tender joints, physicians global assessment of disease activity (PGA), grip force average over 10 seconds (Grippit), Grip Ability Test (GAT), Signals of Functional Impairment (SOFI) in hand, lower limb and upper limb, Health Assessment Questionnaire (HAQ), and pain intensity measured with a visual analogue scale (VAS). The variables were divided into meaningful blocks according to the correlation structure in a principal component analysis (PCA) at M60. Using hierarchical partial least squares (PLS) analyses, this study investigated the blocks cross-sectionally to test for correlations with pain intensity at M0 and M60. The blocks at M0 were also used as predictors of pain intensity at M60 in a hierarchical PLS.

Results: The strongest relationship was found between pain intensity and the second block, consisting of HAQ and SOFI-lower limb at the cross-sectional analyses in both women and men. The block representing disease activity (i.e., ESR, CRP, PGA, and swollen and tender joints) had the weakest relation to pain intensity. According to the longitudinal analyses, the disease activity variables (block 1) at M0 had the strongest relationship to pain intensity at M60 in men. In contrast, HAQ and SOFI-lower limb (block 2) at M0 had a strong relation to pain intensity in women.

Keyword
pain intensity, predictions, principal component analysis, prospective study, Rheumatoid arthritis, sex differences, pain, research, longitudinal method
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13329 (URN)10.1080/09638280701623356 (DOI)
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2013-09-13
4. Sick leave before and after diagnosis of rheumatoid arthritis in relation to referens: A report from the Swedish TIRA project
Open this publication in new window or tab >>Sick leave before and after diagnosis of rheumatoid arthritis in relation to referens: A report from the Swedish TIRA project
Show others...
2009 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 36, no 6, 1170-1179 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Our study describes sick leave during 3 years before and 3 years after diagnosis of rheumatoid arthritis (RA) in relation to referents and identifies predictors for sick leave during the third year after diagnosis of RA.

Methods. One hundred twenty patients (76% women) from the Swedish early RA study TIRA were included. Disease activity and disability were registered regularly during 3 years in TIRA. Referents were matched for sex, age, and home town. Sick leave data were obtained for patients 3 years before and 3 years after diagnosis and for the referents for the corresponding 6 years.

Results. No differences were seen between patients and referents regarding sick leave during the first 2 years, whereas sick leave increased in patients 6 months before diagnosis, from 30% to 53%. During the 3 years after diagnosis, sick leave among patients was rather stable, varying between 50% and 60%, even though disability pension increased and sickness benefit decreased. Sick leave before diagnosis, disability 1 year after diagnosis, and type of work were identified as predictors for sick leave during the third year after diagnosis.

Conclusion. Not surprisingly, sick leave in patients increased the year before diagnosis. Although disease activity and disability diminished after diagnosis, the patients’ sick leave remained essentially unchanged. Sick leave 3 years after diagnosis was foremost predicted by earlier sick leave, disability, and type of work.

Place, publisher, year, edition, pages
Journal of Rheumatology Publishing Co. Ltd., 2009
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13330 (URN)10.3899/jrheum.080523 (DOI)000266891500016 ()
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2013-09-13Bibliographically approved

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