Influence of disease activity on functional capacity in patients with rheumatoid arthritis

Jelena Vladislav Jovanović; Miodrag Stojanović; Vladimir Jovanović; Aleksandar Dimić; Sladjana Božilov; Bojana Stamenković; Saša Milenković

doi:10.2298/2260

Jelena Vladislav Jovanović Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia
Miodrag Stojanović Faculty of Medicine, University of Niš, Niš, Serbia
Vladimir Jovanović Faculty of Medicine, University of Niš, Niš, Serbia
Aleksandar Dimić Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia
Sladjana Božilov Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia
Bojana Stamenković Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia
Saša Milenković Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia

DOI: https://doi.org/10.2298/2260

Keywords: arthritis, rheumatoid, severity of illness index, questionnaires, prognosis,

Abstract

Background/Aim. Progressive erosive changes in cartilage and bone in rheumatoid arthritis (RA) ultimately lead to joint deformities and disability which may be early, severe and permanent. Consequently, there is the reduction of functional ability and changes in the quality of life. The aim of this study was to estimate the impact of disease activity on functional status of patients with RA. Methods. A prospective investigation included 74 patients with RA who were treated in the Rheumatology Clinic of the “Niška Banja” Institute. Assessment of functional status (capacity) was measured by the Health Assessment Questionnaire (HAQ) with the values from 0 to 3 that patients fill out on their own. The patients were then divided into three groups: the group I with the HAQ values from 0.125 to 1.000, the group II with the values from 1.125 to 2.000 and the group III with the values from 2.125 to 3.000. Disease activity was measured by Disease Activity Score (DAS28). The assessment also included sedimentation rate (SE) influence, IgM rheumatoid factor (RF) and C-reactive protein (CRP) positivity, age, and disease duration. Results. The patients with the most severe functional damage estimated by the HAQ – the group III, had the highest values of DAS28 SE (7.4 ± 0.8) compared to the group II (6.5 ± 1.2) and the group I (3.4 ± 1.2). The group III also showed the highest values of DAS28 CRP (7.1 ± 0.8) compared to the group II (6.7 ± 0.8) and the group I (3.6 ± 0.4). Compared with the patients with small and moderate functional damage, the patients in the group III had positive IgM RF and CRP as well as higher SE values more frequently and the difference was statistically significant. In the univariate logistic model, the tested parameters of DAS28 SE, DAS 28 CRP, SE, RF and CRP represent significant predictors of functional disability. The most significant factors that increase the odds of patient having the most severe functional damage include DAS28 SE which increases the odds by 5.5 times (OR = 5.450, 95% CI = 3.211–7.690, p = 0.001), DAS28 CRP by 5.1 times (OR = 5.111, 95% CI = 2.123–10.636, p < 0.01), and the presence of increased CRP (OR = 5.219, 95% CI = 1.305–18.231, p = 0.019) by 5.2 times. Conclusion. Functional status evaluated by the HAQ is a standard for assessment of RA due to its convenience and good correlation with parameters of disease activity. The most significant factors that increase the odds that the patient has the greatest functional damage are DAS28 SE, DAS28 CRP and the presence of CRP.

Author Biography

Jelena Vladislav Jovanović, Institute for Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases “Niška Banja”, Niška Banja, Serbia

Institute for Treatatment and Rehabilitation of Cardiovascular and Rheumatic Diseases, Niska Banja,

Special rehabilitation department,

Vice Chief

References

Marković Z. Rheumatoid arthritis. In: Ilić S, editor. Internal medicine. Niš: Faculty of Medicine University of Niš; 2009. p. 1018−28. (Serbian)

Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum 2001; 44(9): 2009−17.

Radunović G. Monitoring of disease activity in patients with rheumatoid arthritis. Acta Rheumatologica Belgradensia 2008; 38(Suppl 2): 30−5. (Serbian)

Ward MM. Clinical and laboratory measures. In: St Clair EW, Pisetsky DS, Haynes BF. Rheumatoid arthritis. 1st ed. Philadel-phia: Lippincott Williams & Wilkins; 2004. p. 51−63.

van Riel PL, van Gestel AM. Clinical outcomes measures in rheumatoid arthritis. Ann Rheum Dis 2000; 59(Suppl 1): 28−31.

Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 2003; 42(2): 244−57.

Wolfe F. A reappraisal of HAQ disability in rheumatoid arthri-tis. Arthritis Rheum 2000; 43(12): 2751−61.

Sherrer YS, Bloch DA, Mitchell DM, Young DY, Fries JF. The de-velopment of disability in rheumatoid arthritis. Arthritis Rheum 1986; 29(4): 494−500.

Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum 1999; 42(9): 1854−60.

Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou J, et al. Predictive factors of 5-year health assessment question-naire disability in early. J Rheumatol 2003; 30(11): 2344−9.

Courvoisier N, Dougados M, Cantagrel A, Goupille P, Meyer O, Sibilia J, et al. Prognostic factors of 10-year radiographic outcome in early rheumatoid arthritis: a prospective study. Arthritis Res Ther 2008; 10(5): R106.

Young A, Dixey J, Cox N, Davies P, Devlin J, Emery P, et al. How does functional disability in early rheumatoid arthritis (RA) af-fect patients and their lives?, Results of 5 years follow-up in 732 patients from the early RA Study (ERAS). Rheumatology (Oxford) 2000; 39(6): 603−11.

Sokka T, Krishnan E, Häkkinen A, Hannonen P. Functional disa-bility in rheumatoid arthritis patients compared with a com-munity population in Finland. Arthritis Rheum 2003; 48(1): 59−63.

Scott DL, Pugner K, Kaarela K, Doyle DV, Woolf A, Holmes J, et al. The links between joint damage and disability in rheumatoid arthritis. Rheumatology 2000; 39(2): 122−32.

Smedstad LM, Moum T, Guillemin F, Kvien TK, Finch MB, Suur-meijer TP, et al. Correlates of functional disability in early rheumatoid arthritis: a cross-sectional study of 706 patients in four European countries. Br J Rheumatol 1996; 35(8): 746−51.

Jovanović J. Modern diagnostics and the assessment of functional ability of the knee with rheumatoid arthritis [thesis]. Niš: Faculty of Medicine University of Niš; 2005. (Serbian)