Associations of Disease Activity and Socio-demographic Factors with Activity and Participation of Patients with Rheumatoid Arthritis – Results of a Cross-sectional Study

Abstract

Purpose: To analyze the associations of disease activity, functioning and socio-demographic factors with activity and participation in patients with RA, and to characterize the RA population of a specialized multiprofessional hospital based outpatient program (HBOP) for RA at baseline focusing on deficits in functioning and disease activity.

Material and Methods: In a prospective cross sectional study of a HBOP, baseline assessments of patients referred to an academic outpatient department fulfilling the inclusion criteria were studied. Socio-economic data were assessed with a socio-demographic questionnaire, disease activity with the DAS3, DAS4 and RADAI, disability with the HAQ-DI. For statistical analysis, logistic regression models, non-parametric tests, Hosmer-Lemeshow statistic, Variance Inflation Factor and Box-Tidwell tests were used.

Results: Data of 122 consecutive patients (mean age 56 years; 79% female; mean disease duration 10 years) were analyzed. Disease activity (DAS3, DAS4, RADAI) was positively correlated with disability (HAQ-DI) (Spearman correlation coefficients 0.53, 0.56, 0.53; DAS3 and DAS4 0.97). RADAI was significantly associated with HAQ-DI subscores (dressing: OR=1.71, 95% CI 1.32–2.23; gripping: OR=1.67, 95% CI 1.29–2.16). Adjusted for age at diagnosis, sex, education and household size DAS3 and HAQ-DI showed a significant association (OR=2.58, 95% CI 1.71–3.88), similar results were observed for DAS4 and RADAI; and RADAI and gripping and dressing (OR=1.85, 95% CI 1.42–2.40).

Conclusions: Disease activity was positively related with disability and participation. Fine motor skills of the hand were significantly associated with the HAQ-DI. Socio-demographic data seem to be associated with disability.

Zusammenfassung

Fragestellung:Charakterisierung der Patienten mit rheumatoider Arthritis, die an einem spezialisierten multiprofessionellen Tagesklinikprogramm für rheumatoide Arthritis teilgenommen haben, zum Zeitpunkt der Aufnahme hinsichtlich Beeinträchtigungen in der Funktionsfähigkeit und Krankheitsaktivität. Analyse der Zusammenhänge von Krankheitsaktivität, Funktionsfähigkeit und soziodemografischer Faktoren mit Aktivität und Partizipation bei Patienten mit rheumatoider Arthritis.

Material und Methode:In einer prospektiven Querschnittstudie wurden die Eingangs-Assessments von Patienten analysiert, die die Einschlusskriterien für die Aufnahme in die Tagesklinik einer Universitätsklinik erfüllt und deshalb der Ambulanz zugewiesen worden waren. Sozioökonomische Daten wurden mit einem geeigneten Fragebogen erhoben, Krankheitsaktivität mit dem DAS3, DAS4 und RADAI und Beeinträchtigung mit dem HAQ-DI. Für die statistische Auswertung kamen logistische Regressionsmodelle, nicht-parametrische Tests, Hosmer-Lemeshow-Statistik, Variance Inflation-Faktor und Box-Tidwell-Tests zum Einsatz.

Ergebnisse:Analysiert wurden die Daten von 122 Patienten (Durchschnittsalter 56 Jahre; 79% weiblich; mittlere Erkrankungsdauer 10 Jahre). Die Krankheitsaktivität (DAS3, DAS4, RADAI) zeigte eine positive Korrelation mit der Beeinträchtigung (HAQ-DI) (Spearman-Korrelationskoeffizienten 0,53, 0,56, 0,53; DAS3 und DAS4 0,97). Der RADAI zeigte einen signifikanten Zusammenhang mit den Untergruppen des HAQ-DI (Ankleiden OR=1,71, 95% CI 1,32–2,23; Griffkraft OR=1,67, 95% CI 1,29–2,16). Adjustiert für Geschlecht, Ausbildung und Haushaltsgröße sowie das Alter zum Zeitpunkt der Diagnose, zeigten DAS3 und HAQ-DI einen signifikanten Zusammenhang (OR=2,58, 95% CI 1,71–3,88). Ähnliche Ergebnisse wurden für den DAS4 und den RADAI und für den RADAI für Griffkraft und Ankleiden (OR=1,85, 95% CI 1,42–2,40) beobachtet.

Schlussfolgerungen:Die Krankheitsaktivität zeigte einen positiven Zusammenhang mit Beeinträchtigung und Partizipation und die feinmotorischen Fähigkeiten der Hand mit dem HAQ-DI. Soziodemografische Daten scheinen mit Beeinträchtigung im Zusammenhang zu stehen.

Key words

outcome assessment - outpatient rehabilitation - musculoskeletal diseases - medical rehabilitation

Schlüsselwörter

Assessment - konservative Therapie - muskuloskelettale Erkrankungen - Outcomemessung - Rehabilitation

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