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Abstract
Background: Rheumatoid arthritis (RA) is often preceded by symptomatic phases during which classification criteria are not fulfilled. The health burden of these “at-risk” stages is not well described. This study assessed health-related quality of life (HRQoL), function, fatigue and depression in newly presenting patients with clinically suspect arthralgia (CSA), unclassified arthritis (UA) or RA.
Methods: Cross-sectional analysis of baseline Patient-Reported Outcome Measures (PROMs) was conducted in patients from the Birmingham Early Arthritis Cohort. HRQoL, function, depression and fatigue at presentation were assessed using EQ-5D, HAQ-DI, PHQ-9 and FACIT-F. PROMs were compared across CSA, UA and RA and with population averages from the HSE with descriptive statistics. Multivariate linear regression assessed associations between PROMs and clinical and sociodemographic variables.
Results: Of 838 patients included in the analysis, 484 had RA, 200 had CSA and 154 had UA. Patients with RA reported worse outcomes for all PROMs than those with CSA or UA. However, “mean EQ-5D utilities were 0.65 (95%CI: 0.61 to 0.69) in CSA, 0.61 (0.56 to 0.66) in UA and 0.47 (0.44 to 0.50) in RA, which was lower than in general and older (≥ 65 years) background populations.” In patients with CSA or UA, HRQoL was comparable to chronic conditions such as heart failure, severe COPD or mild angina. Higher BMI and older age (≥ 60 years) predicted worse depression (PHQ-9: -2.47 (-3.85 to -1.09), P < 0.001) and fatigue (FACIT-F: 5.05 (2.37 to 7.73), P < 0.001). Women were more likely to report worse function (HAQ-DI: 0.13 (0.03 to 0.21), P = 0.01) and fatigue (FACIT-F: -3.64 (-5.59 to -1.70), P < 0.001), and residents of more deprived areas experienced decreased function (HAQ-DI: 0.23 (0.10 to 0.36), P = 0.001), greater depression (PHQ-9: 1.89 (0.59 to 3.18), P = 0.004) and fatigue (FACIT-F: -2.60 (-5.11 to 0.09), P = 0.04). After adjustments for confounding factors, diagnostic category was not associated with PROMs, but disease activity and polypharmacy were associated with poorer performance across all PROMs.
Conclusions: Patient-reported outcomes were associated with disease activity and sociodemographic characteristics. Patients presenting with RA reported a higher health burden than those with CSA or UA, however HRQoL in the pre-RA groups was significantly lower than population averages.
Original language | English |
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Article number | 307 |
Number of pages | 11 |
Journal | BMC Musculoskeletal Disorders |
Volume | 25 |
Issue number | 1 |
DOIs | |
Publication status | Published - 20 Apr 2024 |
Bibliographical note
No specific funding was received for this work, which was supported by the Research into Inflammatory Arthritis Centre Versus Arthritis (RACE) [grant number 22072]. KR, AF and MC are supported by the NIHR Birmingham Biomedical Research Centre.Keywords
- Patient-reported outcomes measures
- Rheumatoid arthritis
- Unclassified arthritis
- Clinically suspect arthralgia
- Undifferentiated arthritis
- Pre-RA stages
- Functional status
- Health related quality of life
- Fatigue
- Depression
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Rheumatoid Arthritis Centre for Excellence (RACE 2)
Filer, A. (Co-Investigator), Lord, J. (Co-Investigator), Raza, K. (Principal Investigator), Scheel-Toellner, D. (Co-Investigator), Anderson, G. (Co-Investigator), Buckley, C. (Co-Investigator), Clark, A. (Co-Investigator) & Falahee, M. (Co-Investigator)
1/04/19 → 30/09/25
Project: Research