Norton Sam, Fu Bo, Scott David L, Deighton Chris, Symmons Deborah P M, Wailoo Allan J, Tosh Jonathan, Lunt Mark, Davies Rebecca, Young Adam, Verstappen Suzanne M M
Psychology Department, Institute of Psychiatry, King׳s College London, London, UK.
Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK.
Semin Arthritis Rheum. 2014 Oct;44(2):131-44. doi: 10.1016/j.semarthrit.2014.05.003. Epub 2014 May 9.
The Health Assessment Questionnaire is widely used for patients with inflammatory polyarthritis (IP) and its subset, rheumatoid arthritis (RA). In this study, we evaluated the progression of HAQ scores in RA (i) by systematically reviewing the published literature on the methods used to assess changes in functional disability over time and (ii) to study in detail HAQ progression in two large prospective observational studies from the UK.
Data from two large inception cohorts, ERAS and NOAR, were studied to determine trajectories of HAQ progression over time by applying latent class growth models (LCGMs) to each dataset separately. Age, sex, baseline DAS28, symptom duration, rheumatoid factor, fulfilment of the 1987 ACR criteria and socio-economic status (SES) were included as potential predictors of HAQ trajectory subgroup membership.
The literature search identified 49 studies showing that HAQ progression has mainly been based on average changes in the total study population. In the HAQ progression study, a LCGM with four HAQ trajectory subgroups was selected as providing the best fit in both cohorts. In both the cohorts, older age, female sex, longer symptom duration, fulfilment of the 1987 ACR criteria, higher DAS28 and lower SES were associated with increased likelihood of membership of subgroups with worse HAQ progression.
Four distinct HAQ trajectory subgroups were derived from the ERAS and NOAR cohorts. The fact that the subgroups identified were nearly identical supports their validity. Identifying distinct groups of patients who are at risk of poor functional outcome may help to target therapy to those who are most likely to benefit.
健康评估问卷广泛应用于炎症性多关节炎（IP）患者及其子集类风湿关节炎（RA）患者。在本研究中，我们通过系统回顾已发表的关于评估功能残疾随时间变化方法的文献，以及在英国两项大型前瞻性观察性研究中详细研究RA患者的健康评估问卷（HAQ）进展情况，来评估RA患者HAQ评分的进展。
研究了两个大型起始队列ERAS和NOAR的数据，通过分别对每个数据集应用潜在类别增长模型（LCGM）来确定HAQ随时间的进展轨迹。年龄、性别、基线疾病活动评分28（DAS28）、症状持续时间、类风湿因子、是否符合1987年美国风湿病学会（ACR）标准以及社会经济地位（SES）被纳入作为HAQ轨迹亚组归属的潜在预测因素。
文献检索确定了49项研究，表明HAQ进展主要基于整个研究人群的平均变化。在HAQ进展研究中，选择了一个具有四个HAQ轨迹亚组的LCGM，因为它在两个队列中拟合效果最佳。在两个队列中，年龄较大、女性、症状持续时间较长、符合1987年ACR标准、较高的DAS28以及较低的SES与HAQ进展较差的亚组归属可能性增加相关。
从ERAS和NOAR队列中得出了四个不同的HAQ轨迹亚组。所确定的亚组几乎相同这一事实支持了它们的有效性。识别出功能结局较差风险较高的不同患者群体可能有助于将治疗靶向最可能受益的患者。
