Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
Department of Radiology, Auckland District Health Board, Auckland, New Zealand.
Clin Rheumatol. 2018 Aug;37(8):2213-2219. doi: 10.1007/s10067-018-4110-6. Epub 2018 Apr 21.
The objective of the study was to determine clinical factors associated with activity limitation and predictors of a change in activity limitation after 1 year in people with gout. Two hundred ninety-five participants with gout (disease duration < 10 years) attended a baseline assessment which included medical and disease-specific history, pain visual analog score and plain radiographs scored for erosion and narrowing. Activity limitation was assessed using the Health Assessment Questionnaire-II (HAQ-II). After 1 year, participants were invited to complete a further HAQ-II; follow-up questionnaires were available for 182 participants. Fully saturated and stepwise regression analyses were used to determine associations between baseline characteristics and HAQ-II at baseline and 1 year, and to determine predictors of worsening HAQ-II in those with normal baseline scores. Median (range) baseline HAQ-II was 0.20 (0-2.50) and 0.20 (0-2.80) after 1 year of follow-up. Pain score was the strongest independent predictor of baseline HAQ-II, followed by radiographic narrowing score, type 2 diabetes, swollen joint count, BMI, age and urate (model R = 0.51, P < 0.001). Baseline HAQ-II was the strongest predictor of change in HAQ-II at 1 year, followed by tender joint count (model R = 0.19, P < 0.001). Of those with HAQ-II scores of 0 at baseline (n = 59, 32% of those with follow-up data), most did not progress (n = 52, 88%); however, baseline pain score, type 2 diabetes and flare frequency were significant predictors of worsening HAQ-II in this group (R = 0.34, P < 0.001). People with gout experience a wide range of activity limitation, and levels of activity limitation are, on average, stable over a 1-year period. Baseline pain scores are strongly associated with activity limitation and predict development of activity limitation in those with normal HAQ-II scores at baseline.
研究目的在于确定与活动受限相关的临床因素，以及在 1 年内痛风患者活动受限变化的预测因素。295 名痛风患者（病程<10 年）参加了基线评估，包括医学和疾病特异性病史、疼痛视觉模拟评分以及侵蚀和狭窄的普通 X 线评分。使用健康评估问卷-II（HAQ-II）评估活动受限。1 年后，邀请参与者完成进一步的 HAQ-II；182 名参与者可获得随访问卷。使用完全饱和和逐步回归分析来确定基线特征与基线和 1 年 HAQ-II 之间的关联，并确定基线正常评分患者 HAQ-II 恶化的预测因素。中位数（范围）基线 HAQ-II 为 0.20（0-2.50）和 0.20（0-2.80）。疼痛评分是基线 HAQ-II 的最强独立预测因素，其次是放射狭窄评分、2 型糖尿病、肿胀关节计数、BMI、年龄和尿酸（模型 R=0.51，P<0.001）。基线 HAQ-II 是 1 年后 HAQ-II 变化的最强预测因素，其次是压痛关节计数（模型 R=0.19，P<0.001）。基线 HAQ-II 评分为 0 的患者（n=59，随访数据的 32%）中，大多数患者未进展（n=52，88%）；然而，基线疼痛评分、2 型糖尿病和发作频率是该组 HAQ-II 恶化的显著预测因素（R=0.34，P<0.001）。痛风患者的活动受限程度差异很大，且平均而言，活动受限在 1 年内保持稳定。基线疼痛评分与活动受限密切相关，可预测基线 HAQ-II 正常评分患者活动受限的发展。
