Download PDF
Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2015; 25(03): 141-147
DOI: 10.1055/s-0035-1547277
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

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

Aktivität und Partizipation bei Patienten mit rheumatoider Arthritis: Zusammenhänge mit Krankheitsaktivität und soziodemografischen Faktoren – Ergebnisse einer Querschnittstudie
S. Schwarzkopf
1   Department and Institute of Physical and Rehabilitation Medicine and Naturopathy, early postacute Rehabilitation, Hospital of Nuernberg, Paracelsus Medical University, Nuernberg, Germany
,
K.-L. Resch
2   German Institute for Health Research, Bad Elster, Germany
,
H. Kuhlow
3   Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
,
S. Elsner
3   Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
,
E. Grill
4   Institute for Medical Information Processing, Biometry and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Germany
› Author Affiliations
Further Information

Publication History

received 01 October 2014

accepted 25 February 2015

Publication Date:
10 June 2015 (online)

Also available at
    Permissions and Reprints

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
 

  • References

  • 1 Sommer OJ, Kladosek A, Weiler V et al. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radio Graphics 2005; 25: 381-398
    PubMedSearch in Google Scholar
  • 2 Meune C, Touze E, Trinquart L et al. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford) 2009; 48: 1309-1313
    CrossrefPubMedSearch in Google Scholar
  • 3 Radovits BJ, Fransen J, Al SS et al. Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2010; 62: 362-370
    CrossrefPubMedSearch in Google Scholar
  • 4 Radner H, Smolen JS, Aletaha D. Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. www.rheumatology.oxfordjournals.org
    PubMed
  • 5 Radner H, Smolen JS, Aletaha D. Impact of comorbidity on physical function in patients with rheumatoid arthritis. Ann Rheum Dis 2010; 69: 536-541
    CrossrefPubMedSearch in Google Scholar
  • 6 Escalante A, Del Rincon I. How much disability in rheumatoid arthritis is explained by rheumatoid arthritis?. Arthritis Rheum 1999; 42: 1712-1721
    CrossrefPubMedSearch in Google Scholar
  • 7 Scott DL, Symmons DPM, Coulton BL et al. Long-term outcome of treating rheumatoid arthritis: results after 20 years. The Lancet 1987; 16: 1108-1111
    PubMedSearch in Google Scholar
  • 8 Leigh J, Fries JF. Predictors of disability in a longitudinal sample of patients with rheumatoid arthritis. Ann Rheum Dis 1992; 51: 581-587
    CrossrefPubMedSearch in Google Scholar
  • 9 Eberhardt KB, Fex E. Functional impairment and disability in early rheumatoid arthritis – development over 5 years. J Rheumatol 1995; 22: 1037-1042
    PubMedSearch in Google Scholar
  • 10 Feigenbaum SL, Masi AT, Kaplan SB. Prognosis in rheumatoid arthritis. The American Journal of Medicine 1979; 66: 377-384
    CrossrefPubMedSearch in Google Scholar
  • 11 Fleming A, Crown JM, Corbett M. Prognostic value of early features in rheumatoid disease. British Medical Journal 1976; 22: 1243-1245
    PubMedSearch in Google Scholar
  • 12 Wolfe F, Cathey MA. The assessment and prediction of functional disability in rheumatoid arthritis. J Rheumatol 1991; 18: 1298-1306
    PubMedSearch in Google Scholar
  • 13 Uhlig T, Smedstad LM, Vaglum P et al. The course of rheumatoid arthritis and predictors of psychological, physical and radiographic outcome after 5 years of follow-up. J Rheumatol 2000; 39: 732-741
    CrossrefPubMedSearch in Google Scholar
  • 14 Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324
    Search in Google Scholar
  • 15 Felson DT, Anderson JJ, Boers M et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995; 38: 727-735
    CrossrefPubMedSearch in Google Scholar
  • 16 Prevoo MLL, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LBA, van Riel PLCM. Modified disease activity scores that include twenty-eight-joint counts. Arthritis Rheum 1995; 38: 44-48
    CrossrefPubMedSearch in Google Scholar
  • 17 Van der Kooi E, Klarenbeek NB, Güler-Yüksel M et al. A decrease in disease activity score (DAS) level is associated with a decrease in health assessment questionnaire (HAQ) score, independent of follow-up duration, during 5 years of tightly controlled treatment: results from the BeSt study. Ann Rheum Dis 2011; 70: 168-171
    CrossrefPubMedSearch in Google Scholar
  • 18 Ritchie DM, Boyle JA, McInnes JM et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Quarterly J of Medicine, New Series XXXVII 1968; 147: 393-406
    PubMedSearch in Google Scholar
  • 19 Stucki G, Liang MH, Stucki S et al. A self-administered Rheumatoid Arthritis Disease Activity Index (RADAI) for Epidemiologic Research. Arthritis Rheum 1995; 38: 795-798
    CrossrefPubMedSearch in Google Scholar
  • 20 Veehof MM, ten Klooster PM, Taal E et al. Psychometric properties of the Rheumatoid Arthritis Disease Activity Index (RADAI) in a cohort of consecutive Dutch patients with RA starting antitumor necrosis factor treatment. Ann Rheum Dis 2008; 67: 789-793
    CrossrefPubMedSearch in Google Scholar
  • 21 Fries JF, Spitz P, Kraines RG et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137-145
    CrossrefPubMedSearch in Google Scholar
  • 22 Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol 2005; 23: 14-18
    PubMedSearch in Google Scholar
  • 23 Bautista D, Arana E, Martí-Bonmatí L et al. Validation of logistic regression models in small samples: application to calvarial lesions diagnosis. Journal of Clinical Epidemiology 1999; 52: 237-241
    CrossrefPubMedSearch in Google Scholar
  • 24 Lemeshow S, Hosmer DW. A review of goodness-of-fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115: 92-106
    CrossrefPubMedSearch in Google Scholar
  • 25 Nordström DCE, Konttinen YT, Solovieva S et al. In- and out-patient rehabilitation in rheumatoid arthritis. A controlled, open, longitudinal, cost-effectiveness study. Scand J Rheumatol 1996; 25: 200-206
    CrossrefPubMedSearch in Google Scholar
  • 26 Vlieland TPMV, Zwinderman AH, Vandenbroucke JP et al. A randomized clinical trial of in-patient multidisciplinary treatment versus routine out-patient care in active rheumatoid arthritis. British J of Rheumatology 1996; 35: 475-482
    PubMedSearch in Google Scholar
  • 27 Vlieland TPMV, Breedveld FC, Hazes JMW. The two-year follow-up of a randomized comparison of in-patient multidisciplinary team care and routine out-patient care for active rheumatoid arthritis. British J of Rheumatology 1997; 36: 82-85
    PubMedSearch in Google Scholar
  • 28 Barlow JH, Turner AP, Wright CC. Long-term outcomes of an arthritis self-management programme. British J of Rheumatology 1998; 37: 1315-1319
    PubMedSearch in Google Scholar
  • 29 Jacobsson LTH, Frithiof M, Olofsson Y et al. Evaluation of a structured multidisciplinary day care program in rheumatoid arthritis. Scand J Rheumatol 1998; 27: 117-124
    CrossrefPubMedSearch in Google Scholar
  • 30 Scholten C, Brodowicz T, Graninger W et al. Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program. Arch Phys Med Rehabil 1999; 80: 1282-1287
    CrossrefPubMedSearch in Google Scholar
  • 31 Giraudet-Le Quintrec J-S, Mayoux-Benhamou A, Ravaud P et al. Effect of a collective educational program for patients with rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol 2007; 34: 1684-1691
    PubMedSearch in Google Scholar
  • 32 Hammond A, Bryan J, Hardy A. Effects of a modular behavior arthritis education programme: a pragmatic parallel-group randomized controlled trial. J Rheumatol 2008; 47: 1712-1718
    CrossrefPubMedSearch in Google Scholar
  • 33 Da Mota LMH, Laurindo IMM, dos Santos Neto LL. Prospective evaluation of the quality of life in a cohort of patients with early rheumatoid arthritis. Bras J Rheumatol 2010; 50: 249-261
    PubMedSearch in Google Scholar
  • 34 Statistisches Bundesamt, Wiesbaden 2012 . Alleinlebende in Deutschland. Ergebnisse des Mikrozensus 2011; https://www.destatis.de/DE/PresseService/Presse/Pressekonferenzen/2012/Alleinlebende/begleitmaterial_PDF.pdf?__blob=publicationFile
    PubMedSearch in Google Scholar
  • 35 Vlieland TPMV, Buitenhuis NA, van Zeben D et al. Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Annals of the Rheumatic Diseases 1994; 53: 803-806
    CrossrefPubMedSearch in Google Scholar
  • 36 Welsing PMJ, van Gestel AM, Swinkels HL et al. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum 2001; 44: 2009-2017
    CrossrefPubMedSearch in Google Scholar
  • 37 Drossaers-Bakker KW, de Buck M, van Zeben D et al. Long-term course and outcome of functional capacity in rheumatoid arthritis. Arthritis Rheum 1999; 42: 1854-1860
    CrossrefPubMedSearch in Google Scholar
  • 38 Ward MM, Leigh JP. Marital status and the progression of functional disability in patients with rheumatoid arthritis. Arthritis Rheum 1993; 36: 581-588
    CrossrefPubMedSearch in Google Scholar