Predictors of quality of life, functional status, depression and fatigue in early arthritis: comparison between clinically suspect arthralgia, unclassified arthritis and rheumatoid arthritis.

Clinically suspect arthralgia Depression Fatigue Functional status Health related quality of life Patient-reported outcomes measures Pre-RA stages Rheumatoid arthritis Unclassified arthritis Undifferentiated arthritis

Journal

BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565

Informations de publication

Date de publication:
20 Apr 2024
Historique:
received: 14 11 2023
accepted: 15 04 2024
medline: 21 4 2024
pubmed: 21 4 2024
entrez: 20 4 2024
Statut: epublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 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.

Identifiants

DOI: 10.1186/s12891-024-07446-6 PMID: 38643104
pubmed: 38643104
doi: 10.1186/s12891-024-07446-6
pii: 10.1186/s12891-024-07446-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

307

Informations de copyright

© 2024. The Author(s).

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Auteurs

Barbara Torlinska (B)

Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.

Karim Raza (K)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.
NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, UK.

Andrew Filer (A)

Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.
NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, UK.

Gurpreet Jutley (G)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.

Ilfita Sahbudin (I)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.
Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Ruchir Singh (R)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.

Paola de Pablo (P)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.

Elizabeth Rankin (E)

Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Benjamin Rhodes (B)

Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Nicole Amft (N)

Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Elizabeth Justice (E)

Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Catherine McGrath (C)

Department of Rheumatology, Frimley Park Hospital NHS Foundation Trust, Camberley, UK.

Sangeetha Baskar (S)

Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.

Jeanette Trickey (J)

Department of Rheumatology, The County Hospital, Wye Valley NHS Trust, Hereford, UK.

Melanie Calvert (M)

Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK.
Health Data Research UK, London, UK.

Marie Falahee (M)

Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK. m.falahee@bham.ac.uk.

Classifications MeSH