Kalke S, Mukerjee D, Dasgupta B
Department of Rheumatology, Southend Hospital, Prittlewell Chase, Essex SSO ORY, UK.
Rheumatology (Oxford). 2000 Aug;39(8):883-5. doi: 10.1093/rheumatology/39.8.883.
To evaluate the Health Assessment Questionnaire (HAQ) in the assessment of functional status, its responsiveness to change with treatment and its correlation with conventional disease activity indices in polymyalgia rheumatica (PMR).
Newly diagnosed patients with PMR, satisfying modified Jones and Hazleman criteria, were recruited to the study. The clinical assessments, including early morning stiffness (EMS), pain measured on a horizontal 10 cm visual analogue scale (VAS), C-reactive protein (CRP) and the HAQ, were carried out 0, 6, 12 and 24 weeks after treatment had been started. Any comorbid condition likely to affect the HAQ was noted.
Eighteen patients completed the 6-month assessment period. These included four males and 14 females, with a mean age of 68.5 years. Pretreatment mean disease activity showed EMS of 68 min, VAS pain of 69 mm, CRP of 46 mg/l and a HAQ score of 1.57. At 6 months, mean EMS had declined to 4 min, VAS pain to 11 mm, CRP to 9 mg/l and the HAQ score to 0.14. Linear regression analysis of HAQ vs EMS, VAS and CRP showed correlation coefficients of 0.72, 0.66 and 0.63, respectively. Standardized response means (SRM), a measure of responsiveness, for HAQ, EMS, VAS and CRP were 3, 1.7, 1. 8 and 1.6, respectively. We assessed each section of the HAQ individually to see if any particular daily activity was more responsive to change. Questions on dressing and grooming, rising and eating were more responsive to change (SRM 2.5, 2.7 and 1.8, respectively) than questions about walking, hygiene, reach, grip and activities (SRM 0.8, 1.4, 1.2, 1.1 and 1.1, respectively).
The HAQ is useful in the assessment of functional status in PMR, is responsive to change and correlates well with conventional indices of disease activity. However, fixed disabilities like osteoarthritis, shoulder capsulitis and systemic diseases may affect its interpretation. The sections of the HAQ measuring disability related to inflammatory stiffness/proximal involvement showed greater responsiveness to change than other sections, and hence may have a greater role in evaluating disease activity in PMR.
评估健康评估问卷（HAQ）在风湿性多肌痛（PMR）功能状态评估中的作用、其对治疗变化的反应性以及与传统疾病活动指标的相关性。
招募符合改良Jones和Hazleman标准的新诊断PMR患者。在开始治疗后的0、6、12和24周进行临床评估，包括晨僵（EMS）、用10 cm水平视觉模拟量表（VAS）测量的疼痛、C反应蛋白（CRP）和HAQ。记录任何可能影响HAQ的合并症。
18例患者完成了6个月的评估期。其中男性4例，女性14例，平均年龄68.5岁。治疗前平均疾病活动度显示EMS为68分钟，VAS疼痛为69 mm，CRP为46 mg/L，HAQ评分为1.57。6个月时，平均EMS降至4分钟，VAS疼痛降至11 mm，CRP降至9 mg/L，HAQ评分降至0.14。HAQ与EMS、VAS和CRP的线性回归分析显示相关系数分别为0.72、0.66和0.63。作为反应性指标的标准化反应均值（SRM），HAQ、EMS、VAS和CRP分别为3、1.7、1.8和1.6。我们分别评估了HAQ的每个部分，以确定是否有任何特定的日常活动对变化更敏感。关于穿衣和修饰、起身和进食的问题对变化更敏感（SRM分别为2.5、2.7和1.8），而关于行走、卫生、够物、握力和活动的问题（SRM分别为0.8、1.4、1.2、1.1和1.1）则不然。
HAQ在评估PMR的功能状态方面有用，对变化有反应，且与传统疾病活动指标相关性良好。然而，骨关节炎、肩周炎和全身性疾病等固定性残疾可能会影响对其的解读。HAQ中测量与炎性僵硬/近端受累相关残疾的部分对变化的反应性比其他部分更大，因此在评估PMR的疾病活动中可能发挥更大作用。
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