University of Washington and Swedish Medical Center, 601 Broadway, Suite 600, Seattle, WA 98122.
Stanford University, 306 Ramona Road, Portola Valley, CA 94028.
Semin Arthritis Rheum. 2018 Dec;48(3):436-448. doi: 10.1016/j.semarthrit.2018.05.010. Epub 2018 May 23.
Patients with psoriatic arthritis (PsA) experience substantial physical impairment. This is commonly assessed using the patient-reported Health Assessment Questionnaire-Disability Index (HAQ-DI), which was originally developed in rheumatoid arthritis. The purpose of this review is to examine the value and challenges of using the HAQ-DI in patients with PsA, and to discuss alternative measures of functional impairment in this condition.
A literature search was performed in the MEDLINE, BIOSIS Previews, Embase, Derwent Drug File, and SciSearch databases using relevant terms and key words. Additional references from personal libraries were identified by the authors.
Although validated in PsA, the HAQ-DI has limitations, including marked floor effects, lack of responsiveness to treatment effects in later disease stages, and underestimation of physical impairment in patients whose symptoms are predominantly skin related. Nonetheless, it has been widely used in clinical trials of PsA treatment and is generally responsive to change with effective therapy, discriminating between active and placebo treatments. Other generic or arthritis-specific patient-reported questionnaires with a focus on physical impairment include the Medical Outcomes Study Short Form-36 Health Survey, the EuroQol-5D, the Arthritis Impact Measurement Scales, and the Routine Assessment of Patient Index Data 3. There are currently no PsA-specific instruments to assess physical function, but health-related quality-of-life questionnaires with elements related to functional impairment include the PsA Quality of Life questionnaire, the PsA Impact of Disease questionnaire, and VITACORA-19. As the available measures of physical impairment may not reflect the impact of all aspects of PsA on a patient, additional health-related quality-of-life instruments, such as the Dermatology Life Quality Index, may be used in parallel to obtain a more complete picture of the disease burden.
The HAQ-DI is a valuable assessment tool that clinicians should continue to use in clinical trials and practice. Because instruments to specifically assess physical function in patients with PsA are currently lacking, clinicians should consider using a combination of instruments to conduct the most thorough evaluation possible.
患有银屑病关节炎（PsA）的患者会经历严重的身体损伤。这通常通过患者报告的健康评估问卷-残疾指数（HAQ-DI）来评估，该指数最初是在类风湿关节炎中开发的。本文的目的是检查在 PsA 患者中使用 HAQ-DI 的价值和挑战，并讨论在这种情况下评估功能损伤的替代方法。
通过相关术语和关键词在 MEDLINE、BIOSIS Previews、Embase、Derwent Drug File 和 SciSearch 数据库中进行文献检索，并由作者确定个人图书馆中的其他参考文献。
尽管在 PsA 中得到了验证，但 HAQ-DI 存在局限性，包括明显的地板效应、在疾病后期阶段缺乏对治疗效果的反应能力，以及对症状主要与皮肤相关的患者的身体损伤估计不足。尽管如此，它已在 PsA 治疗的临床试验中广泛使用，并且通常对有效的治疗有反应，能够区分活跃治疗和安慰剂治疗。其他关注身体损伤的通用或关节炎特异性患者报告问卷包括医疗结果研究简表-36 健康调查、欧洲五维健康量表、关节炎影响测量量表和患者索引数据常规评估 3。目前尚无专门用于评估身体功能的 PsA 特定工具，但包含与功能损伤相关元素的健康相关生活质量问卷包括 PsA 生活质量问卷、PsA 疾病影响问卷和 VITACORA-19。由于现有的身体损伤评估工具可能无法反映 PsA 对患者的所有方面的影响，因此可能需要使用其他健康相关生活质量工具，例如皮肤病生活质量指数，以更全面地了解疾病负担。
HAQ-DI 是一种有价值的评估工具，临床医生应继续在临床试验和实践中使用。由于目前缺乏专门评估 PsA 患者身体功能的工具，临床医生应考虑使用多种工具进行最全面的评估。
