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Juvenile Idiopathic Arthritis (JIA) and Rheumatoid arthritis (RA) are autoimmune chronic inflammatory disorders of undetermined cause. Uveitis is one of the commonest and most dangerous extra-articular manifestations of JIA and RA presenting chronic anterior uveitis with non-specific biomarkers for its early detection. We evaluated the role of serum 14-3-3 Eta protein to assess its potential role as a novel biomarker for the early detection of uveitis in Egyptian JIA and RA patients as well as its correlation with disease activity. A case-control study included three patient groups: group I includes 42 JIA patients, group II includes 42 RA patients, and an equal number of apparently healthy individuals matched in sex and age for each group of patients as controls, recruited from the rheumatology outpatient clinic. All participants were subjected to clinical examination, laboratory investigations with assessment of serum levels of 14-3-3 Eta protein, and ophthalmologic investigations to assess disease activity, eye affection, and its relation to 14-3-3 Eta protein level, and other disease variables among those patients. a statistically significant difference was estimated between the two patients' groups and controls regarding 14-3-3 Eta protein level. 14-3-3 Eta protein has a significant positive correlation with disease activity in JIA and RA patients. Also, RA patients with clinical uveitis had higher levels of the 14-3-3 Eta protein, while there were no significant differences among JIA patients with or without uveitis. 14-3-3 Eta protein is a potential diagnostic biomarker in early detection of uveitis in RA patients, as it is higher in patients versus controls especially those with uveitis with a cut-off point 57.5, at which patients must have a thorough eye examination to receive early intervention and, to prevent complications, while it doesn't have the same role in JIA patients. 14-3-3 Eta protein is a potential diagnostic and prognostic marker for JIA and RA being correlated with disease activity. [ABSTRACT FROM AUTHOR]

Objetivo: Avaliar características da versão brasileira do Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire (BOMFAQ) e da versão em português do Health Assessment Questionnaire (HAQ) para identificar dependência funcional. Métodos: Estudo transversal de amostra aleatória dos idosos (60+ anos) do município de Ouro Preto em 2002. Foram considerados dependentes os idosos com muita dificuldade ou incapacidade para realizar adaptapelo menos uma atividade de vida diária. As causas de dependência foram agrupadas nos domínios mobilidade, saúde mental, órgãos dos sentidos segundo exame médico e ganho de peso. Análise estatística foi realizada por meio do teste do Qui-quadrado. Resultados: Foram avaliados 102 idosos pelo exame médico, sendo 89 idosos classificados como dependentes e 13 como controles. O HAQ e BOMFAQ apresentaram sensibilidade de 58% e 83%, especificidade de 85% e 69%, valores de predição positiva de 79% e 73% e negativa de 67% e 81%, respectivamente. O HAQ apresentou boa sensibilidade, especificidade e valores de predição para identificar dependência no domínio mobilidade. O BOMFAQ demonstrou sensibilidade boa ou excelente, mas especificidade e valores de predição positivo baixos em todos os domínios. Os testes apresentaram boa acurácia intraobservador, mas baixa acurácia interobservador. Conclusões: O HAQ é adequado para o rastreamento de dependência funcional no domínio mobilidade numa população geral de idosos. Por sua baixa especificidade, o BOMFAQ pode superestimar a prevalência de dependência. A baixa acurácia interobservador deverá ser considerada no planejamento dos estudos que utilizem esses instrumentos.

As the clinical course of systemic sclerosis (SSc) varies widely, prognostic indicators have been sought to predict the outcomes of individual patients. Racial differences in SSc render it necessary to validate prognostic indicators in different patient cohorts. In this study, we aimed to assess clinical and laboratory parameters in Japanese patients with early‐stage SSc with diffuse cutaneous involvement and/or interstitial lung disease, and identify predictive factors for disease progression. We performed multivariate analyses of baseline clinical information to estimate symptoms 4 years later in Japanese patients with diffuse cutaneous SSc and/or SSc with interstitial lung disease. Patients were enrolled in the study within 5 years of disease onset at 10 Japanese SSc centers. Over 12 years, 115 patients followed up for 4 years were included in this study. The modified Rodnan skin score (mRSS) at 4 years correlated with the baseline mRSS and finger‐to‐palm distance, defined as the average length from the distal tip of the fourth finger to the distal palmar crease. The percentage predicted vital capacity (%VC) in year 4 positively and negatively correlated with initial %VC and the presence of anti‐topoisomerase I antibodies, respectively. The Health Assessment Questionnaire Disability Index (HAQ‐DI) at 4 years was positively and negatively associated with baseline HAQ‐DI and %VC, respectively. The occurrence of digital ulcers within 4 years was associated with the initial presence of digital ulcers, finger‐to‐palm distance, and the presence of digital pitting scars and anti‐topoisomerase I antibodies. This study identified several factors that may predict the progression of early‐stage SSc in Japanese patients. Finger‐to‐palm distance may be a useful tool for predicting the progression of skin thickening and the development of digital ulcers in the early stages of severe SSc, but larger, long‐term prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of Complementary and Alternative Medicine (CAM) use on functional status and pain relief in patients with Chronic Rheumatic Diseases (CRDs) using the Visual Analogue Pain Scale (VAS) and Health Assessment Questionnaire (HAQ). This cross-sectional multicentre study involved patients from rheumatology outpatient clinics who met the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) criteria for rheumatic disease diagnosis. The exclusion criteria included acute flares or comorbid conditions that could interfere with the outcomes. Data collection included demographic and clinical data, pharmacotherapy, CAM usage, and its impact on the VAS and HAQ scales. The study included 126 patients. A significant proportion (57%) reported CAM use, with a preference for one (67%) or multiple (33%) modalities. CAM users exhibited significantly lower VAS scores, indicating reduced pain perception, and lower HAQ scores, suggesting better functional status than non-users. Correlation analyses highlighted strong positive associations between patient age, disease duration, and CAM use preference, as well as between educational level and specific CAM therapies. CAM use among patients with CRDs is associated with significant improvements in pain perception and functional capacity, as evidenced by lower VAS and HAQ scores. These findings suggest the potential of CAM to complement conventional rheumatology treatments, highlighting its value in patient-centered care and indicating its role in improving patient outcomes. However, the study's cross-sectional design and reliance on self-reported data necessitate further research for causal inferences and robust establishment of CAM efficacy. [ABSTRACT FROM AUTHOR]

Objective. We sought to evaluate the quality and timeliness of patient-reported outcome (PRO) measure reporting, which have not been previously studied. Methods. Clinical trials that informed new US Food and Drug Administration (FDA) approvals for the first rheumatological indication between 1995 and 2021 were identified. Data were recorded to determine whether collected PROs were published, met minimum clinically important difference (MCID) or statistical significance (P < 0.05) thresholds, and were consistent with Consolidated Standards of Reporting Trials (CONSORT)-PRO standards. Hazard ratios and Kaplan-Meier estimate were used to assess the time from FDA approval to PRO publication. Results. Thirty-one FDA approvals corresponded with 110 pivotal trials and 262 reported PROs. Of the 90 included studies, 1 (1.1%) met all 5 recommended items, 10 (11.1%) met 4 items, 17 (18.9%) met 3 items, 21 (23.3%) met 2 items, 26 (28.9%) met 1 item, and 15 (16.7%) met none of the reporting standards. Most PROs met MCID thresholds (149/262; 56.9%) and were statistically significant (223/262; 85.1%). Of our subset analysis, one-third of PROs were not published upfront (70/212; 33%) and 1 of 9 (22/212; 10.4%) remained unpublished = 4 years after initial trial reporting. Publication rates were highest for the Health Assessment Questionnaire-Disability Index (97.4%) and lowest for the 36-item Short Form Health Survey (81.8%). Less than half of these published PROs met MCID and statistical significance thresholds (94/212; 44.3%). Conclusion. One in 9 PROs remained unpublished for = 4 years after initial trial reporting, and compliance with CONSORT-PRO reporting guidelines was poor. Efforts should be made to ensure PROs are adequately reported and expeditiously published. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of Complementary and Alternative Medicine (CAM) use on functional status and pain relief in patients with Chronic Rheumatic Diseases (CRDs) using the Visual Analogue Pain Scale (VAS) and Health Assessment Questionnaire (HAQ). This cross-sectional multicentre study involved patients from rheumatology outpatient clinics who met the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) criteria for rheumatic disease diagnosis. The exclusion criteria included acute flares or comorbid conditions that could interfere with the outcomes. Data collection included demographic and clinical data, pharmacotherapy, CAM usage, and its impact on the VAS and HAQ scales. The study included 126 patients. A significant proportion (57%) reported CAM use, with a preference for one (67%) or multiple (33%) modalities. CAM users exhibited significantly lower VAS scores, indicating reduced pain perception, and lower HAQ scores, suggesting better functional status than non-users. Correlation analyses highlighted strong positive associations between patient age, disease duration, and CAM use preference, as well as between educational level and specific CAM therapies. CAM use among patients with CRDs is associated with significant improvements in pain perception and functional capacity, as evidenced by lower VAS and HAQ scores. These findings suggest the potential of CAM to complement conventional rheumatology treatments, highlighting its value in patient-centered care and indicating its role in improving patient outcomes. However, the study's cross-sectional design and reliance on self-reported data necessitate further research for causal inferences and robust establishment of CAM efficacy. [Med-Science 2024; 13(3.000): 557-63]

Introduction/Aims: Little is known about skeletal muscle injury with coronavirus disease 2019 (COVID‐19). We estimate the frequency and explore the patterns of skeletal muscle injury in acute COVID‐19. Methods: A cohort of COVID patients with mild to moderate symptoms were evaluated in a COVID‐designated hospital between May and December 2021 and followed for 2 weeks. Skeletal muscle injury was assessed according to creatine kinase (CK) levels, Manual Muscle Test‐8 (MMT‐8) score, and the Health Assessment Questionnaire (HAQ) score. Injury was defined as CK >200 IU/L with an MMT‐8 score < 76. The association between such injury and severity and outcomes were evaluated using cross‐tabulations. Results: Two hundred fifty participants with a mean age of 50.2 years (SD: 17.2) were included. One hundred nine (43.6%) were women; 84 (34%) developed severe disease. Median CK levels were 91 IU/L (IQR 56–181). [Correction added on 17 November 2023, after first online publication: In the preceding sentence, the IQR was corrected from '56,181'.] Patients with weakness on the MMT‐8 (n = 247, 98.8%) and disability on the HAQ (n = 107; 42.8%) were common. Neck flexor muscles were prominently affected. Skeletal muscle injury was seen in 22.4% (95% CI: 17.4–28.1). There was no significant association between skeletal muscle injury and maximal severity of illness or short‐term outcomes. Disability increased over 14 days in most survivors (n = 172, 72.3%) and this was not seen in those with mild disease (OR: 0.4, 95% CI: 0.22–0.70). Discussion: Skeletal muscle injury appears to be common in people presenting with mild to moderate COVID infection. [ABSTRACT FROM AUTHOR]

Background: We investigated sensitivity to change of three scoring methods of the Health Assessment Questionnaire (HAQ) in relation to change in disease activity in patients with active rheumatoid arthritis (RA). Patients and Methods: Adult RA-patients with complete data in the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology database with respect to the 20 HAQ questions and disease activity score with 28-joint count using the erythrocyte sedimentation rate (DAS28-ESR) for 2 visits, at least 6-12 months apart, and high disease activity (DAS28-ESR >5.1) at visit 1. Changes in HAQ scored by the (1) conventional method (HAQ-8), (2) HAQ-Tomlin method (HAQ-T), and (3) HAQ-20-item method (HAQ-20) were analyzed in relation to the European League Against Rheumatism (EULAR) RA response criteria, dichotomized to good/moderate and no response. Results: In 421 patients, mean standard deviation (SD) DAS28-ESR declined significantly (6.1 [0.8]-4.8 [1.6], P < 0.0001), over a mean period (SD) of 8.7 (1.9) months. Median HAQ scores improved by all three scoring methods, HAQ-8 (1.6-1.4); HAQ-T (1.2-0.7); and HAQ-20 (1.2-0.9) with similar effect sizes of 0.97, 0.96, and 0.95, respectively. The proportion who achieved a HAQ minimally clinically important improvement (MCII) of =0.22 was significantly higher in 47% of patients with EULAR good/moderate score compared to the no response patients (64% vs. 11%, P < 0.0001). Good/moderate EULAR response, higher baseline DAS28, and higher baseline HAQ (7.11, 1.55, and 1.06, respectively) were independent predictors of achieving a HAQ-MCII. Conclusion: Three HAQ scoring methods performed similarly in sensitivity to change with no advantage of alternative scoring methods compared to the conventional HAQ-8 method. A good/moderate EULAR response, despite long disease duration, was associated with a significant likelihood of achieving a HAQ-MCII. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease that results in the destruction of joints, connective tissues, muscle, tendons and fibrous tissue. Until now, there are no cure therapies. Objective: We aimed to assess the effectiveness of Tai Chi (TC) on RA patients by meta-analysis. Methods: The PubMed, Cochrane Library, EMBASE, web of science, China National Knowledge Infrastructure and Google Scholar were searched up to January 2023. We included randomized controlled trials (RCTs) or controlled clinical trials (CCTs) comparing TC to control conditions for RA patients. Review Manager (Version 5.3) software was used to analyze outcomes of time to walk 50 feet, joint tenderness, number of swollen joints or tender joints, handgrip strength, pain, the Health Assessment Questionnaire (HAQ) and withdraws overall. Results: A total of 351 patients with RA from six RCTs and three CCTs were included for meta-analysis. TC could also significantly decrease withdrawals overall in studies (OR = 0.28, 95% CI 0.12 to 0.67, p = 0.002). No significant treatment effects of physical function were identified of the other outcomes. Conclusion: Our findings indicated that TC was safe to RA patients, but it cannot improve physical function and pain. However, there is still lack of more evidence. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_ record.php?RecordID=367498], identifier [CRD42022367498]. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) patients have decreased functional ability and restricted access to healthcare facilities and are on a spectrum of medications. These can impact their oral health. This study aims to investigate the association between periodontal disease and OA disease parameters, specifically the functional disability and the medications taken. This was a cross-sectional study on OA participants recruited from the Hospital Canselor Tuanku Mukhriz. Periodontal health parameters were obtained from an oral examination of the participants. A Health Assessment Questionnaire (HAQ) was administered to ascertain the functional status of the participants. Out of the 130 participants recruited, 71 (54.6%) had periodontitis. There was a correlation between the teeth count with OA severity, where participants with a greater Kellgren–Lawrence score had less teeth (rs = 0.204, p = 0.025). Participants with a greater degree of functional limitation also had less teeth (rs = −0.181, p = 0.039) and a higher clinical attachment loss (rs = 0.239, p = 0.006). There were no associations found between the symptomatic slow-acting drugs in OA and periodontal health parameters. In conclusion, there was a high proportion of periodontitis in patients with OA. Functional disability was associated with measures of periodontal health. It is suggested that clinicians treating OA patients consider the need for a referral for dental care when managing this group of patients. [ABSTRACT FROM AUTHOR]

Objective. To describe psoriatic arthritis (PsA) flares and their effect on patient-reported outcomes (PROs). Methods. Cross-sectional surveys of rheumatologists/dermatologists and their patients with PsA were conducted in France, Germany, Italy, Spain, the United Kingdom, and the United States, capturing data on physician-reported patient flare status, demographics, PsA severity, and clinical outcomes. Patient-completed surveys captured data on PROs: 5-level EuroQol 5-dimension, Work Productivity and Activity Impairment questionnaire, Health Assessment Questionnaire-Disability Index, and 12-item Psoriatic Arthritis Impact of Disease questionnaire. Patients were compared by flare status using parametric and nonparametric tests. Multivariate regression was used to identify flare associations. Multivariate logistic regression adjusted for patient demographics and physician specialty assessed the effect of flare status. Results. Among 2238 patients (586 from the US, 1652 from Europe) managed by 572 physicians, physician-reported flare was present for 168 patients (7.5%), and self-reported flare was present for 95 patients (10% of available data). Mean (SD) flare count over 12 months was 2.2 (4.9), lasting on average 16.4 (16.2) days. Flare status was linked to worse PROs. Patients who had not flared in the last 12 months or had never flared had a higher quality of life, lower overall work impairment, and a lower degree of disability compared with patients who were currently experiencing a flare (all; P < 0.01). Conclusion. Actively experiencing a flare adversely affected QOL, disability, and work productivity. PsA flares should be routinely assessed and managed in clinical care. [ABSTRACT FROM AUTHOR]

Background and Objectives: Juvenile Idiopathic Arthritis (JIA) and Rheumatoid arthritis (RA) are autoimmune chronic inflammatory disorders of undetermined cause. Uveitis is one of the commonest and most dangerous extra-articular manifestations of JIA and RA presenting chronic anterior uveitis with non-specific biomarkers for its early detection. We evaluated the role of serum 14-3-3 Eta protein to assess its potential role as a novel biomarker for the early detection of uveitis in Egyptian JIA and RA patients as well as its correlation with disease activity., Methods: A case-control study included three patient groups: group I includes 42 JIA patients, group II includes 42 RA patients, and an equal number of apparently healthy individuals matched in sex and age for each group of patients as controls, recruited from the rheumatology outpatient clinic. All participants were subjected to clinical examination, laboratory investigations with assessment of serum levels of 14-3-3 Eta protein, and ophthalmologic investigations to assess disease activity, eye affection, and its relation to 14-3-3 Eta protein level, and other disease variables among those patients., Results: a statistically significant difference was estimated between the two patients' groups and controls regarding 14-3-3 Eta protein level. 14-3-3 Eta protein has a significant positive correlation with disease activity in JIA and RA patients. Also, RA patients with clinical uveitis had higher levels of the 14-3-3 Eta protein, while there were no significant differences among JIA patients with or without uveitis., Conclusion: 14-3-3 Eta protein is a potential diagnostic biomarker in early detection of uveitis in RA patients, as it is higher in patients versus controls especially those with uveitis with a cut-off point 57.5, at which patients must have a thorough eye examination to receive early intervention and, to prevent complications, while it doesn' t have the same role in JIA patients. 14-3-3 Eta protein is a potential diagnostic and prognostic marker for JIA and RA being correlated with disease activity., Competing Interests: Conflict of interest The authors claim that no financial assistance or other benefits were provided by commercial organizations to them for the research that is presented in this paper. Additionally, they attest to the absence of any financial ties between the writers that would create the appearance of or result in a conflict of interest regarding the research. The writers claim to have no competing interests., (© 2024 Dalia Salah Saif, Manar Fawzy Dawoud, Abeer Medhat, Dina Rifaat Al Sharaki, Dina Salem Fotoh, published by De Gruyter on behalf of NCRC-DID.)

Introduction: Association between oral health and rheumatoid arthritis is well established. Oral health-related quality of life was determined in patients diagnosed with rheumatoid arthritis (RA). Materials and Methods: This study was conducted among 45 patients (males 25 and female 20) (Group I) of RA and 45 healthy participants as control (Group II). Disease activity score 28 test, health assessment questionnaire (HAQ), and general oral health assessment index (GOHAI) questionnaire were applied. Results: The mean HAQ score in Group I was 1.14 and in Group II was 0.36. The mean GOHAI score in Group I was 36.4 and in Group II was 52.8. The mean HAQ in males was 0.94 and in females was 34.6. The mean GOHAI in males was 12.6 and in females was 38.2. In Group I, there were 15 patients with HAQ level 1 and 30 with HAQ level 2 and in Group II was 40 with HAQ levels 1 and 5 with HAQ level 2. In Group I, 42 had Dt GOHAI = 0 and 3 had Dt GOHAI = 1 and in Group II, 10 had Dt GOHAI = 0 and 35 had Dt GOHAI = 1. The difference was statistically significant (P < 0.05). There was a statistically significant difference in the mean value of HAQ and GOHAI in degree of disease activity (P < 0.05). There was an increase in HAQ and decreases GOHAI scores with the deterioration of disease. There was a correlation between age and involved joints with HAQ and inverse relationship between age and involved joints with GOHAI. Conclusion: Authors found that RA patients had poor oral health quality of life. It was found that aging and with the deterioration of disease, GOHAI, and the oral health quality of life of patients decreased.

Objective: To further refine the wording of screening questions and examine their face validity through cognitive interviews with axial spondyloarthritis (axSpA) and chronic mechanical back pain patients. Methods: In-depth, semi-structured cognitive interviews were conducted with 30 patients (10 axSpA; 20 chronic mechanical back pain patients) to assess the face validity and comprehensibility of the screening questions. The interview protocol focused on 12 questions/domains including participants' feedback/thoughts on the duration of suffering from back pain, age at onset of back pain, pace of back pain development, improvement of pain with movement or rest, nocturnal back pain improving upon awakening, pain in other parts of the body, responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID) use, history of autoimmune conditions, and domains such as sleep, sitting, and stiffness. The Flesch-Kincaid grade level and Flesch reading ease scores were then analyzed for the revised versions of screening questions. Results: Participants preferred questions that allowed them to provide more details regarding the frequency of their symptoms. Questions were refined for clarity and eliminated if participants considered them to be irrelevant (e.g., NSAIDs). Two sample screeners were derived from twelve questions each with an overall reading grade of 7.5 and reading ease of 65.7%. Conclusions: It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain. An evidence-based approach to demonstrate the validity of the screening tool will be critical for it to be implemented widely into clinical practice. Key Points • Our study developed two sample screeners that are clear to individuals with back pain and accessible to most with an overall Flesch-Kincaid reading grade of 7.5 and Flesch reading ease of 65.7%. • Questions that were considered irrelevant to participants were eliminated such as responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID). • It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests that factors beyond disease activity associate with functional disability in RA. The primary study objective was to explore associations between comorbidities, sociodemographic factors and functional outcomes at five and 10 years. Methods RA patients from two UK prospective cohorts were grouped into low (<1.5) and high (≥1.5) five- and 10-year health assessment questionnaire (HAQ) score. Clinical variables (e.g. disease activity, rheumatoid nodules, erosions) and sociodemographic factors (e.g. ethnicity, deprivation) were recorded at baseline and yearly thereafter. Comorbidity was measured using the Rheumatic Diseases Comorbidity Index (RDCI). Binary logistic regression models were fitted using multiple imputation. Results In total, 2701 RA patients were recruited (mean age 56.1 years, 66.9% female). A total of 1718 (63.4%) had five-year and 820 (30.4%) 10-year follow-up data. In multivariable analysis, no association was found between RDCI and HAQ ≥ 1.5 at five or 10 years. Sociodemographic factors (increased age at disease onset, female gender, minority ethnicity) were associated with higher odds of HAQ ≥ 1.5 at five and 10 years, with worse deprivation additionally associated with HAQ ≥ 1.5 at 10 years (OR 0.79, 95% CI: 0.69, 0.90). Conclusion Comorbidities at baseline have not been found to be associated with worse RA functional outcome in the long-term. On the other hand, sociodemographic factors, independently of disease measures, are associated with worse functional outcome in RA at five and 10 years, in models adjusting for comorbidity burden. Tailoring management interventions according to not only clinical disease parameters but also patient sociodemographic factors may improve long-term outcomes including functional disability. [ABSTRACT FROM AUTHOR]

Background: In this prospective cohort study the objective was to identify the socio-demographic and clinical factors that influence treatment response to disease-modifying antirheumatic drugs (DMARDs) at ambulatory multicenter rheumatology outpatient clinics. The subjects were patients with rheumatoid arthritis satisfying the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria with informed consent., Materials and Methods: Pre-coded data sheets were used to capture socio-demographic and clinical characteristics. Baseline data was collected at time of patient recruitment. Only patients who had complete data at three-month follow-up were included in the study analysis. The study's outcome was achievement of remission or low disease activity. The study used the adherence in chronic disease scale and European Task Force for Patient Evaluation of General Practice tools to evaluate patient adherence and assessments of health care received. Data analysis was carried out using Prism 7 and SPSS. Categorical data were regulated as percentages, while continuous data were regulated as means and standard deviation. Prevalence (at 95% CIs) of various socio-demographic and clinical characteristics were calculated comparisons of socio-demographic characteristics, clinical characteristics between patients into achieved primary/secondary outcomes and those who didn't were carried out using the chi-square statistic (for categorical variables) and independent student T-test (for continuous variables). Logistic regression was performed to estimate the impact of moderator variables on study outcomes and to calculate adjusted odds ratio (OR) with corresponding 95% CI. Throughout analysis α < 0.05 was considered statistically significant., Results: A total of 206 patients were included. The mean age was 51.2 ± 15.1 years; mostly females (n=188 patients, 91.3%). Majority had attained post-primary education (n=172 patients, 83.5%). Only 74 patients (35.9%) had formal professional employment, while only six patients (3%) paid for healthcare via government-funded/private insurance. At recruitment, nearly half of the included patients had moderate to severe disability. Majority of patients had elevated baseline erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Most of the patients (90.3%) had a positive rheumatoid factor test at recruitment, while 58% had a positive anti-cyclic citrullinated peptide test. Majority had moderate disease activity. Thirty-three patients were in remission, 9.7% had low disease activity while 12.6% had high disease activity. Majority of patients (94.2%) were on non-steroidal anti-inflammatory drugs, non-biological DMARDs (80.6%) and systemic corticosteroids (54.9%). Mean duration of follow-up was 4.6 months. At follow-up, 37.9% found the system to be acceptable, 63.6% found the system to be problematic. Majority of the patients reported to have been adherent to therapy (high adherence: 7.8%; moderate adherence: 86.9%). The proportion of patients who achieved remission or low disease activity increased significantly at three-month follow-up., Conclusion:  Having shorter disease duration, lower unemployment rates, higher income, lower non-adherence rates, having a positive outlook towards the healthcare system, normal CRP baseline, normal ESR baseline, and lower baseline of functional disability were significantly associated with increased chances of low disease activity/remission., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Kenyatta National Hospital (KNH)/University of Nairobi (UoN) Ethics and Research Committee issued approval P674/12/2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Study was supported by grants from Pfizer. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Oyoo et al.)

Objectives: This study aimed to evaluate the impact of exercise therapy on patient-reported outcomes (PROs) in rheumatoid arthritis (RA) as part of the process of updating the 2020 Japanese guidelines for the management of RA according to the Grading of Recommendations, Assessment, Development, and Evaluation system. Methods: We searched PubMed, Japana Centra Revuo Medicina Web, and the Cochrane Library (from 2009 to 2018) to identify articles that evaluated PROs of exercise therapy and RA disease activity. Results: A total of 662 articles were identified, including nine RCTs, and meta-analyses were performed on six RCTs on systemic exercise therapy and three RCTs on upper extremity exercise therapy. Analyzed exercise therapies were diverse, differing in target population, intervention method, and duration. Significant improvements were observed in the Health Assessment Questionnaire Disability Index (mean difference -0.35, 95% confidence interval (CI): -0.60 to -0.10), pain (standardized mean difference -2.04, 95% CI: -3.77 to -0.32), and SF-36. For upper extremity exercise therapy, significant improvements in PROs (Disabilities of the Arm, Shoulder, and Hand Questionnaire, Michigan Hand Outcome Questionnaire) were observed. Conclusion: Exercise therapy in RA treatment improves patient subjective assessment of pain, physical function, and quality of life. [ABSTRACT FROM AUTHOR]

Objective: To compare physical function scales of the Multidimensional Health Assessment Questionnaire (MDHAQ) with that of the Health Assessment Questionnaire-Disability Index (HAQ-DI) in patients with psoriatic arthritis (PsA), and to examine whether either questionnaire is less prone to "floor effects."Methods: Data were collected prospectively from 2018 to 2019 across 3 UK hospitals. All patients completed physical function scales within the MDHAQ and HAQ-DI in a single clinic visit. Agreement was assessed using medians and the Bland-Altman method. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability.Results: Two hundred ten patients completed the clinic visit; 1 withdrew consent. Thus, 209 were analyzed. Sixty percent were male, with mean age of 51.7 years and median disease duration of 7 years. In clinic, median MDHAQ and HAQ-DI including/excluding aids scores were 0.30, 0.50, and 0.50 respectively. Although the median score for HAQ-DI was higher than for MDHAQ, the difference between the 2 scores was mostly within 1.96 SDs from the mean, suggesting good agreement. The ICCs demonstrated excellent test-retest reliability for both the MDHAQ and HAQ-DI. Similar numbers of patients scored 0 on the MDHAQ and HAQ-DI including/excluding aids (48, 47, and 49, respectively). Using a score of ≤ 0.5 as a cutoff for minor functional impairment, 23 patients had a MDHAQ ≤ 0.5 when their HAQ-DI including aids was > 0.5. Conversely, 4 patients had a MDHAQ > 0.5 when the HAQ-DI including aids was ≤ 0.5.Conclusion: Both the MDHAQ and HAQ-DI appear to be similar in detecting floor effects in patients with PsA. [ABSTRACT FROM AUTHOR]

Context: Knee Osteoarthritis (OA) is a common disorder affecting the elderly population in the Asia-Pacific region. The goals of OA treatment include alleviation of pain and improvement of functional status. There is lack of consensuses regarding the management of knee OA. Aims: The main aim of this study is to evaluate any synergistic effect of adding lateral wedge insoles to viscosupplementation. Settings and Design: This is a randomized interventional study in which total 60 patients were selected from a tertiary care center and divided in two equal groups using computerized block randomization. Methods and Material: Group A got only VS while Group B got VS with LWI. Assessment was done at baseline and then after 2nd, 4th and 12thweeks after the intervention by using Visual Analogue Scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function and Health Assessment Questionnaire (HAQ) for quality of life. Statistical Analysis Used: The data were entered in MS EXCEL spreadsheet and analysed by using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In this study all the patients in both group showed statistically significant improvement in VAS, WOMAC and HAQ on all three follow-ups over the baseline assessment (P value < 0.0005). On inter-group comparison, statistically significant better results were noticed in the WOMAC scores of group B at 2nd week and 4th week (P value

Abstract Background The Health Assessment Questionnaire-Disability Index (HAQ-DI) is used to assess functional status in rheumatoid arthritis (RA), but the change required for meaningful improvements remains unclear. A minimum clinically important difference (MCID) of 0.22 is frequently used in RA trials. The aim of this study was to determine a statistically defined critical difference for HAQ-DI (HAQ-DI-dcrit) and evaluate its association with therapeutic outcomes. Methods We retrospectively analyzed data from adult German patients with RA enrolled in a multicenter observational trial in which they received adalimumab therapy at the decision of the treating clinician during routine clinical care. The HAQ-DI-dcrit, defined as the minimum change that can be reliably discriminated from random long-term variations in patients on stable therapy, was determined by evaluating intra-individual variation in patient scores. Other outcomes of interest included Disease Activity Score-28 joints and patient-reported pain and fatigue. Results The HAQ-DI-dcrit was calculated as an improvement (decrease) from baseline of 0.68 in a discovery cohort (N = 1645) of RA patients on stable therapy and with moderate disease activity (mean DAS28 [standard deviation] of 4.4 [1.6]). In the full patient cohort (N = 2740), 22.1% of patients achieved a HAQ-DI-dcrit improvement at month 6. Compared with patients with a small improvement in HAQ-DI (decrease of ≥0.22 to

Abstract Background No previous studies have characterized a patient’s experience of rheumatoid arthritis (RA) management in Greece and unmet needs may exist despite a broad range of available treatments. Therefore, we assessed quality of life (QoL), functional ability, and healthcare resource utilization in patients with established RA and receiving treatment in a tertiary care setting in Greece. Methods This was a prospective, observational cohort of patients aged ≥18 years, receiving any type of treatment for RA, and followed for 12 months at 7 rheumatology referral centers across mainland Greece (NCT01001182). Patient data were collected at the initial visit and 3, 6, and 9 months. QoL was evaluated using the Euro Quality of Life-5 dimensions questionnaire (EQ-5D) and functional ability was evaluated using the Health Assessment Questionnaire (HAQ). Results A total of 210 patients with RA were enrolled (76.7% women, mean ± standard deviation [SD] age: 59.1 ± 12.6 years, median [interquartile range] disease duration: 11.9 [5.0–16.0] years). Baseline mean ± SD EQ-5D and HAQ scores were 0.57 ± 0.32 and 0.75 ± 0.63, respectively, and remained largely unchanged throughout the study. Post-hoc comparison showed that patients receiving non-biologic disease-modifying antirheumatic drugs (non-bDMARDs) had significantly higher EQ-5D and lower HAQ-DI scores compared with those receiving biologic DMARDs. A majority of patients reported having difficulty doing housework or other duties (61.4 and 61.9%, respectively), and 55.2% reported needing external support for these tasks. Positive correlation was observed between QoL and functional ability. Hospitalization at least once during the study occurred in 9.5% of the patients, and 12.5% of these cases were due to exacerbation of RA. At baseline, 52.4% of the patients were retired, with 38.5% of retirees having retired early due to RA. Among the patients who were retired at baseline, the mean ± SD period from actual retirement to expected retirement age was 12.1 ± 8.1 years. Conclusion QoL and functional ability were positively correlated in patients with long-standing RA, with a large proportion showing impairments in both. Timely, target-oriented treatment initiated as soon as possible after diagnosis may help to improve patient-reported outcomes and limit the burden of RA. Trial registration ClinicalTrials.gov NCT01001182. Registered 23 October 2009.

Objective: The Childhood Health Assessment Questionnaire (CHAQ), though widely used for assessments in pediatric rheumatology, has drawbacks, including low correlation to disease activity and ceiling effects. We sought to determine if any tools from the Patient Reported Outcomes Measurement Information System (PROMIS) improve on these shortcomings and/or are preferred by patients.Methods: Patients 5-17 years of age with juvenile idiopathic arthritis (JIA) or juvenile dermatomyositis (JDM) were recruited from the rheumatology clinics at a Canadian children's hospital. Participants completed the CHAQ, 3 PROMIS measures (pain interference, mobility, and physical activity), and underwent a standard clinical assessment.Results: Fifty-two patients participated, 25 with JIA and 27 with JDM. None of the PROMIS measures suffered from ceiling effects, whereas the CHAQ Disability Index (DI) and pain visual analog scales both did, with 50% and 20% of patients achieving the best possible scores, respectively. The PROMIS mobility was moderately correlated to the CHAQ-DI (rs -0.60, 95% CI -0.75 to -0.40), and the PROMIS pain interference was strongly correlated to the CHAQ pain score (rs 0.65, 95% CI 0.43-0.80). No measures correlated with disease activity. Patients preferred the PROMIS to the CHAQ.Conclusion: The PROMIS pain interference, mobility, and physical activity measures improve in some areas where the CHAQ is weak: they do not suffer from ceiling effects, and patients prefer the PROMIS tools. More work is needed to determine the correlation and responsiveness of the PROMIS tools to changes in disease activity over time before they should be widely adopted for clinical use. [ABSTRACT FROM AUTHOR]

Objective: Patients with rheumatoid arthritis (RA) who also have diabetes mellitus (DM) might have worse clinical outcomes and adverse events compared to patients with RA who do not have DM. We evaluated the effects of DM on Health Assessment Questionnaire (HAQ) changes and outpatient infection rates in patients with RA.Methods: Using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) electronic health record-based registry, we identified patients with RA who had ≥ 1 rheumatologist visit with a HAQ measured in 2016 (index visit), ≥ 1 previous visit, and a subsequent outcome visit with the same HAQ measured at 12 months (± 3 months). We identified DM by diagnosis codes, medications, or laboratory values. Outpatient infection was defined by diagnosis codes or antiinfective medications. We calculated mean HAQ change and incidence rate (IR) of outpatient infections among patients with and without DM. Generalized linear models and Cox regression were used to calculate the adjusted mean HAQ change and HRs.Results: We identified 3853 RA patients with DM and 18,487 without DM. The mean HAQ change between index and outcome visit among patients with DM was 0.03 and without DM was 0.002 (P < 0.01). We identified 761 outpatient infections for patients with DM with an IR of 22.6 (95% CI 21.0-24.2) per 100 person-years and 3239 among patients without DM with an IR of 19.8 (95% CI 19.1-20.5). The adjusted HR of outpatient infections among patients with DM was 0.99 (95% CI 0.91-1.07), compared to patients without DM.Conclusion: Patients with RA with concomitant DM had greater worsening, or less improvement, in their functional status, suggesting additional interventions may be needed for RA patients with DM to optimize treatment and management of other comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: Association between oral health and rheumatoid arthritis is well established. Oral health-related quality of life was determined in patients diagnosed with rheumatoid arthritis (RA). Materials and Methods: This study was conducted among 45 patients (males 25 and female 20) (Group I) of RA and 45 healthy participants as control (Group II). Disease activity score 28 test, health assessment questionnaire (HAQ), and general oral health assessment index (GOHAI) questionnaire were applied. Results: The mean HAQ score in Group I was 1.14 and in Group II was 0.36. The mean GOHAI score in Group I was 36.4 and in Group II was 52.8. The mean HAQ in males was 0.94 and in females was 34.6. The mean GOHAI in males was 12.6 and in females was 38.2. In Group I, there were 15 patients with HAQ level 1 and 30 with HAQ level 2 and in Group II was 40 with HAQ levels 1 and 5 with HAQ level 2. In Group I, 42 had Dt GOHAI = 0 and 3 had Dt GOHAI = 1 and in Group II, 10 had Dt GOHAI = 0 and 35 had Dt GOHAI = 1. The difference was statistically significant (P < 0.05). There was a statistically significant difference in the mean value of HAQ and GOHAI in degree of disease activity (P < 0.05). There was an increase in HAQ and decreases GOHAI scores with the deterioration of disease. There was a correlation between age and involved joints with HAQ and inverse relationship between age and involved joints with GOHAI. Conclusion: Authors found that RA patients had poor oral health quality of life. It was found that aging and with the deterioration of disease, GOHAI, and the oral health quality of life of patients decreased. [ABSTRACT FROM AUTHOR]

Objectives: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions. Design: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model. Participants: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke. Results: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created. Conclusion: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).

Ewelina Bąk,1 Czesław Marcisz,2 Adriana Borodzicz,3 Danuta Sternal,1 Sylwia Krzemińska3 1Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland; 2Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland; 3Department of Clinical Nursing Faculty of Health Sciences, Medical University, Wroclaw, Poland Purpose: The main purpose of this study was to compare the level of health-related quality of life (HRQoL) using Nottingham Health Profile (NHP) in Polish patients with rheumatoid arthritis (RA) during therapy applying disease-modifying antirheumatic drugs (DMARDs) with conventional synthetics (csDMARDs) or with csDMARDs in combination with biological drugs (bDMARDs). The second purpose was to analyze the correlation between the domain values of NHP and the demographic and clinical parameters, functional efficiency, and mood. Patients and methods: The studies involved 212 patients with RA, divided into two groups: group I – 126 persons treated using csDMARDs, group II – 86 patients using csDMARDs in combination with bDMARDs. A diagnostic survey was used applying NHP for HRQoL, Beck Depression Inventory (BDI), and Health Assessment Questionnaire (HAQ). The 28-Joint Disease Activity Score (DAS-28) was calculated. Results: The patients with RA in both studied groups did not differ significantly in terms of all the NHP domains, values of HAQ and BDI. The DAS-28 value, the number of swollen joints, and the duration of morning stiffness were significantly smaller among patients from group II. However, in both groups, the majority of the analyzed components of NHP demonstrated significant correlations with values of HAQ and BDI and some of the domains of NHP – with DAS-28. Conclusion: The level of HRQoL, functional efficiency, and mood are comparable in patients treated conventionally and in combination with biological drugs. The HRQoL level shows correlation with the occurrence of depression symptoms, and the energy level, the sensation of pain, and physical abilities are covariates with daily activities. The intensity of the activity of RA as well as experiencing pain and the duration of morning stiffness is smaller among patients applying csDMARDs plus bDMARDs compared with patients treated only conventionally. Keywords: patients with rheumatoid arthritis in Poland, DMARDs, biological therapy, health-related quality of life, Nottingham Health Profile, Beck Depression Inventory, Health Assessment Questionnaire

Abstract Background Versions of the Health Assessment Questionnaire (HAQ) are commonly used to measure physical functioning across multiple rheumatic diseases but there has been no clear demonstration that any HAQ version is actually generic. This study aimed to show that the HAQ-II instrument is invariant across different rheumatic disease categories using the Rasch measurement model, which would confirm that the instrument is generic. Methods HAQ-II responses from 882 consecutive rheumatology clinic attendees were fitted to a Rasch model. Invariance across disease was assessed by analysis of variance of residuals implemented in RUMM2030. Rasch modeled HAQ-II scores across disease categories were compared and the mathematical relationship between raw HAQ-II scores and Rasch modeled scores was also determined. Results The HAQ-II responses fitted the Rasch model. There was no substantive evidence for lack of invariance by disease category except for a single item (“opening car doors”). Rasch modeled scores could be accurately obtained from raw scores with a cubic formula (R2 0.99). Patients with rheumatoid arthritis had more disability than patients with other kinds of inflammatory arthritis or autoimmune connective tissue disease. Conclusions The HAQ-II can be used across different rheumatic diseases and scores can be similarly interpreted from patients with different diseases. Transforming raw scores to Rasch modeled scores enable a strictly linear, interval scale to be used. It remains to be seen how that would affect interpretation of change scores. Trial registration ANZCTR ACTRN12617001500347. Registered 24th October 2017 (retrospectively registered).

Objective:Rheumatoid arthritis (RA) is a systemic disease that is primarily characterized by chronic inflammation of the diarthrodial joints. Synovitis, joint erosions and functional impairment are main findings of the disease. In this study, we aimed to investigate whether functional impairment is related to radiological erosions in RA.Material and Method:Sixty-eight patients who were diagnosed to have RA according to American College of Rheumatology (ACR) criteria were included in the study. The demographic characteristics of patients, duration and severity of morning stiffness imprisonment, and the severity of pain were recorded. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. Disease activity was assessed by Ritch Index and DAS28 score, and functional status by Health Assessment Questionnaire (HAQ) and Duruöz Hand Index (DHI). The severity of the erosions was graded according to the Larsen Score from radiographs of hands and feet.Results:Patients had the mean age of 54.30±11.27 and an average disease duration of 8.4±6.4 years. There was no correlation between HAQ and DHI and Larsen Score (p>0.05). However, statistically significant correlation was found between HAQ and DHI with duration and severity of morning stiffness, verbal pain score, Ritch Index and DAS 28(p>0.05).Conclusion:The radiological erosisons in patients with RA may not be an indicator of functional status. Therefore, we think that not only radiological evaluation but also functional status must be followed regularly in the treatment and follow-up of RA.

Objective This study aimed to longitudinally evaluate the association between rheumatoid arthritis (RA) and locomotive syndrome (LS) in RA patients using the 25-question Geriatric Locomotive Function Scale (GLFS-25). Methods Subjects were 58 RA patients (female, 48 (82.8%); mean age, 60.9 ± 10.9 years) who had GLFS-25 scores available for five consecutive years and who did not have LS at baseline (i.e. GLFS-25 < 16 points). Associations between DAS28-CRP and the development of LS were determined using linear regression analysis and receiver operating characteristic (ROC) curve analysis. Results Subjects were divided into the LS group (n = 15, GLFS-25 ≥ 16 points) and non-LS group (n = 43, GLFS-25 < 16 points) based on GLFS-25 scores at the 5th year of the study period. In the LS group, DAS28-CRP worsened every year. The linear regression model adjusted for age and sex revealed that ΔGLFS-25 increased by 3.80 (95% confidence interval: 1.81-5.79) each time ΔDAS28-CRP increased by 1 (p<.001). Among patients in remission (DAS28-CRP < 2.3), 13.5% had LS. ROC curve analysis yielded a five-year mean DAS28-CRP of 1.99 (sensitivity, 86.7%; specificity, 62.8%) as the cut-off point for the development of LS. Conclusion Tight control of RA disease activity for deeper remission may be needed to prevent the development of LS. [ABSTRACT FROM AUTHOR]

Evidence suggests that inflammation has a harmful effect on muscle strength as well as on functional disability. The purpose of the present study was to examine the association of objectively measured disease activity levels and functional disability among Iranian patients with Rheumatoid Arthritis (RA), and to analyse whether a Persian version of the health assessment questionnaire-disability index (PHAQ-DI) can distinguish between RA patients at different stages of the disease progression. 198 RA patients were requested to complete the PHAQ-DI. The disease activity score for each patient was evaluated using the disease activity score (DAS-28). The association analysis between the PHAQ-DI scores and the four levels of disease activity was measured using a Spearman correlation coefficient. A Kruskal-Wallis analysis was utilized to determine differences in PHAQ-DI scores among the levels of disease activity. The Receiver operating characteristic (ROC) curve was also utilized to determine the PHAQ-DI total score cut-off for predicting the level of disease activity. Spearman's correlation coefficients between the PHAQ-DI and the disease activity level ranged between 0.59 and 0.75. There were significant differences in the PHAQ-DI total score among known groups with various disease activity levels (P = 0.001); However, HAQ-DI total score could not differentiate the remission phase from low disease activity levels in patients with RA (p = 0.37). The PHAQ-DI total score cut-off for distinguishing remission-low disease activity from moderate-high disease activity was 1.19, with a specificity of 0.91 and a sensitivity of 0.615. The present findings provide evidence for the degree to which the PHAQ-DI measures identify and distinguish disease activity levels in patients with rheumatoid arthritis. The PHAQ-DI questionnaire, as a patient-administered, non-invasive, fast, inexpensive and available tool, can be used in the rheumatologist's office as a substitute for determining disease activity in patients with active RA. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms. Method: Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact. Results: Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS global health perception was 68 ± 62 out of 100. Stiffness severity was correlated with tender joint counts (ρ = 0.46) and pain intensity (ρ = 0.40). All three measures were equally well correlated with the EuroQol-VAS global health perception. Pain and tender joints were better correlated with the HAQ-DI (ρ = 0.68 and ρ = 0.63), but stiffness was more strongly correlated with several quality of life domains, including mobility. Swollen joints were a poor predictor of outcomes. Conclusions: Musculoskeletal stiffness following chikungunya infection is distinct from arthralgia. It does not always occur in the same patients or with a corresponding intensity. Joint pain and stiffness may be independently associated with disability and quality of life assessments. [ABSTRACT FROM AUTHOR]

Abstract Background In patients with tender and swollen finger joints, the differential diagnosis between rheumatoid arthritis (RA) and osteoarthritis (OA) of the hands can be initially difficult. This prospective study (the TryCort study) was performed to study the diagnostic value of prednisolone in differentiating between RA and hand OA. We present the results of this potentially diagnostic test in patients with possible RA in daily clinical practice by demonstrating the results of a pilot and a validation part of this ‘prednisolone test’ (pred-test). Methods We investigated the response to a 3-day course of 20 mg of prednisolone in patients with suspicion of RA. All patients received 1 g of paracetamol per day for 5 days for pain relief. On days 3–5, a morning dose of 20 mg of prednisolone was added. Hand pain was quantified on a 0–10 Numerical Rating Scale, and the subjective percentage of improvement (0–100%) was recorded. Thresholds for response to prednisolone were investigated in a pilot phase with differentiation in response between patients with RA and patients with OA of the hands, both with pain in the hands ≥4. In a validation phase, the best differentiating cut-off of the pilot phase was applied to discriminate responders from non-responders in consecutive patients with hand pain ≥4 referred because of suspected RA. Final diagnoses were made by the expert upon re-examination at week 12. Primary outcomes were the sensitivity and specificity of a positive test in relation to the diagnosis. Results A percentage of 40% subjective improvement of pain in the hands on day 3 discriminated best between RA and OA in the pilot phase. Among 95 patients with complete data in the validation phase, RA was diagnosed in about 50%. Patients with RA had more swollen joints, higher C-reactive protein levels and slightly higher Health Assessment Questionnaire scores. The pred-test was positive in 42.1% of all patients (40 of 95). The median percentage of improvement on day 5 was higher in RA than in non-RA: 50% (IQR 30–60%) vs. 20% (IQR 10–30%) (p

Objectives: At our hospital, orthopedic surgeons and physical and occupational therapists have developed bodyweight exercises for the lower and upper extremities (BELU) for rheumatoid arthritis (RA) patients, including walking [Timed Up-and-Go (TUG) test and figure-of-eight walking) and weight exercises. We aimed to clarify the effect of bodyweight exercise and the Health Assessment Questionnaire (HAQ) cut-off value for a TUG test result of 12 s (or longer) as a risk factor for a fall., Methods: All patients underwent BELU twice weekly at home for 6 weeks. We assessed the HAQ score, TUG time, and the strengths of quadriceps femoris, biceps brachii, handgrip, side pinch, and pulp pinch before and after the intervention., Results: We analyzed the data of 42 participants. The mean age was 67.0 ± 12.1 years. The mean Disease Activity Score-28 for rheumatoid arthritis with erythrocyte sedimentation rate was 2.91 ± 0.91. The mean HAQ score was 0.69 ± 0.62. The dominant quadriceps femoris, biceps brachii, pulp pinch, and side pinch strengths were significantly strengthened. TUG time was improved from 9.0 ± 3.0 s to 8.6 ± 3.2 s (P=0.009). The receiver operating characteristic analysis revealed the cut-off value of HAQ for a TUG time of 12 s (or longer) was 1.0 (AUC 0.903, 95% confidence interval 0.792-1.0)., Conclusions: Bodyweight exercises strengthened the muscles in female patients with RA, resulting in improved TUG test results. An indicative HAQ cut-off value of 1.0 (or greater) was identified for a TUG test result of 12 s or longer., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interest., (2024 The Japanese Association of Rehabilitation Medicine.)

Objective: To translate, cross‐culturally adapt and validate the Health Assessment Questionnaire‐Disability Index (HAQ‐DI) in Nepali language (Nepali HAQ). Methods: Translation was done fulfilling the methodological standards described by Beaton. Comprehensibility testing of the preliminary version was done in 50 rheumatoid arthritis (RA) patients, and a prefinal version was prepared after making changes in the original version to maintain the equivalence with the target version. Psychometric testing was done in another group of 127 rheumatoid patients to test for content validity and reliability. Construct validity was tested with visual analog score (VAS) and numeric rating scales (NRS) for pain and stiffness. Results: Nepali HAQ was comprehensible in >95% of patients. Reliability testing showed an intraclass coefficient for overall Nepali HAQ of 0.76, ranging from 0.71 to 0.95. The internal consistency was acceptable with a Cronbach's alpha of.92. Construct validity was also acceptable with a moderate correlation between Nepali HAQ and VAS and NRS. Conclusions: Nepali HAQ is a comprehensible, reliable and valid tool for evaluation of the functional status of Nepalese patients with RA and should be implemented in clinical care and research settings. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the prevalence of locomotive syndrome (LS) using the 25-question geriatric locomotive function scale (GLFS-25) and identify factors associated with LS in elderly and younger patients with rheumatoid arthritis (RA). Methods: Overall, 390 patients with RA who underwent GLFS-25 measurement, bone mineral density determination, and bioelectrical impedance analysis were enrolled. Factors associated with LS were analyzed by comparing patients with and without LS among both elderly and younger patients with RA. Results: The prevalence of LS was 41.5%, 47.7% and 32.3% in all patients, elderly patients, and younger patients with RA, respectively. Pain visual analog scale (VAS) and Health Assessment Questionnaire Disability Index (HAQ-DI) were associated with LS in both elderly and younger patients. Moreover, in younger patients with RA, disease activity score in 28 joints (DAS28), erythrocyte sedimentation rate (ESR), basal metabolic rate, and legs muscle mass were identified as being associated with LS. Conclusion: This study demonstrated that to prevent LS, we should aim to control pain and maintain a low HAQ-DI in elderly and younger patients with RA, and improve disease activity and maintain a higher basal metabolic rate, and legs muscle mass in younger patients with RA. [ABSTRACT FROM AUTHOR]

The article assesses the clinical state of locomotive syndrome in older patients with rheumatoid arthritis. Topics discussed include the relationship between rheumatoid arthritis and locomotive syndrome, validation of geriatric locomotive function scale in the involved patients, and the comparison with the Health Assessment Questionnaire Disability Index.

Idiopathic inflammatory myopathies (IIM) are progressive, debilitating diseases that can lead to severe impairment. The aim of the study was to evaluate the level of disability and compare it between different subtypes of IIM as well as to estimate clinical symptoms associated with greater risk of disability and distinguish the most troublesome activities in this group of patients. A online form concerning clinical symptoms, comorbidities and limitations in daily living was created and distributed to online support groups for patients with IIM. Health Assessment Questionnaire was used to estimate disability and physical limitations while visual analogue scales enabled to assess the intensity of clinical symptoms. 361 out of 377 responders were included for further evaluation. High prevalence of disability was observed in each subtype yet predominantly in patients with inclusion body myositis (IBM) as 51.43% of them fulfilled the criteria of severe to very severe disability. Level of disability correlated with muscle weakness, tolerance of physical activity and level of fatigue. 45.62% of responders in general required walking devices and 43.50% of participants declared using facilitating devices for maintaining hygiene. Patients with IIM encounter multitude physical limitations that can be partially compensated by usage of facilitating devices or aid of the caregivers. IBM seems to be the most disabling subtype. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the Health Assessment Questionnaire Disability Index (HAQ‐DI) reflects objective measures of physical function in people with osteoarthritis (OA) and rheumatoid arthritis (RA). Methods: In total, 139 people, 71 with RA fulfilling the American College of Rheumatology (ACR) criteria (1987) and 68 with OA fulfilling ACR criteria for OA of the hip or knee, completed the HAQ‐DI. Physical function was assessed using Timed Up and Go (TUG), 30 seconds Sit to Stand (STS), grip strength dynamometry and pedometer steps over 7 days. Results: The strongest association with HAQ‐DI was with the TUG (R2 of 0.671 and 0.512 in RA and OA groups, respectively). HAQ‐DI and STS showed a non‐linear association in both groups with R2 of 0.380 in RA and 0.359 in OA. A strong association was found between HAQ‐DI and grip strength in the OA group (R2 = 0.681), whereas the RA group showed a moderate association (R2 = 0.285). There was a strong association between the HAQ‐DI and pedometer measures in RA (R2 = 0.562), although this association was weak in OA (R2 = 0.156). Conclusion: The HAQ‐DI has a strong association with the TUG in both RA and OA. There was variable association between the HAQ‐DI and other physical performance measures, as well as differences between the RA and OA cohorts. In order to form a full and accurate clinical picture, health professionals should perform both subjective patient‐reported outcome measures and objective physical performance measures of disability. [ABSTRACT FROM AUTHOR]

The study aims to analyze the association between the bone and cartilage/periarticular components of the radiographic joint damage and disability over the course of disease, in a cohort of rheumatoid arthritis (RA) patients from a day-to-day clinical practice. The secondary aim is to study the role of demographic and disease-related variables in this association. We performed a retrospective longitudinal study including 736 RA patients. Disability was assessed with the health assessment questionnaire (HAQ), and radiographic joint damage of hands and wrists with the Sharp van-der-Heijde score (total (SHS), erosion (ES), and narrowing/(sub)luxation (NSLS) components]. Generalized estimating equations models, adjusted by disease activity, demographic and disease-related variables, were used to test the relationship between SHS and medium-term (median value of the HAQs performed in the following year after each radiograph) and long-term (set of HAQ measures performed during follow-up, at least 1 year apart from the first x-ray) disability. Interaction terms between the SHS and demographic and disease-related variables were introduced in the models. To account for multiple testing, Bonferroni correction was applied. NSLS was independently associated with medium-term disability, even after Bonferroni correction. We observed significant and positive interactions between NSLS and age at x-ray, and with the ES. SHS showed no association with long-term disability. The cartilage/soft tissue component of the radiographic joint damage seems to exert a much more important role in medium-term disability than the erosive component. This association could be modulated by the age at the x-ray and by the magnitude of the erosive damage. [ABSTRACT FROM AUTHOR]