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.
BMC Musculoskelet Disord. 2024 Apr 20;25(1):307. doi: 10.1186/s12891-024-07446-6.
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.
类风湿关节炎（RA）常伴有症状期，在此期间分类标准不适用。这些“高危”阶段的健康负担尚未得到充分描述。本研究评估了新出现的临床可疑性关节炎（CSA）、未分类关节炎（UA）或 RA 患者的健康相关生活质量（HRQoL）、功能、疲劳和抑郁情况。
对伯明翰早期关节炎队列中患者的基线患者报告的结果测量（PROMs）进行了横断面分析。使用 EQ-5D、HAQ-DI、PHQ-9 和 FACIT-F 评估了患者就诊时的 HRQoL、功能、抑郁和疲劳情况。使用描述性统计数据，比较了 CSA、UA 和 RA 之间以及与 HSE 人群平均值之间的 PROMs。多元线性回归评估了 PROMs 与临床和社会人口统计学变量之间的相关性。
在纳入分析的 838 名患者中，484 名患有 RA，200 名患有 CSA，154 名患有 UA。与 CSA 或 UA 患者相比，患有 RA 的患者在所有 PROMs 方面的报告结果均较差。然而，“平均 EQ-5D 效用值在 CSA 中为 0.65（95%CI：0.61 至 0.69），在 UA 中为 0.61（0.56 至 0.66），在 RA 中为 0.47（0.44 至 0.50），低于一般人群和年龄较大（≥65 岁）的背景人群。”在 CSA 或 UA 患者中，HRQoL 与心力衰竭、严重 COPD 或轻度心绞痛等慢性疾病相当。较高的 BMI 和年龄（≥60 岁）预示着更严重的抑郁（PHQ-9：-2.47（-3.85 至-1.09），P<0.001）和疲劳（FACIT-F：5.05（2.37 至 7.73），P<0.001）。女性更有可能报告功能（HAQ-DI：0.13（0.03 至 0.21），P=0.01）和疲劳（FACIT-F：-3.64（-5.59 至-1.70），P<0.001）更差，而居住在较贫困地区的人功能（HAQ-DI：0.23（0.10 至 0.36），P=0.001）、抑郁（PHQ-9：1.89（0.59 至 3.18），P=0.004）和疲劳（FACIT-F：-2.60（-5.11 至 0.09），P=0.04）更严重。在调整了混杂因素后，诊断类别与 PROMs 无关，但疾病活动度和多药治疗与所有 PROMs 的较差表现相关。
患者报告的结果与疾病活动度和社会人口统计学特征有关。与 CSA 或 UA 相比，出现 RA 的患者报告的健康负担更高，但预 RA 组的 HRQoL 明显低于人群平均值。
