Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
BMJ Open. 2024 May 2;14(5):e082020. doi: 10.1136/bmjopen-2023-082020.
We aimed to provide a comprehensive assessment of health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) of different activities and to evaluate the correlation between clinical activity measures and HRQoL instruments. This research also analysed the extent to which different aspects of HRQoL (physical, psychological and social) were affected.
Cross-sectional, observational, non-interventional study.
The study was conducted at the Department of Rheumatology and Immunology, Qilu Hospital, Shandong University.
From December 2019 to October 2020, a total of 340 RA patients participated in the survey using convenient sampling. Three generic instruments, EQ-5D-5L,SF-12 and the AQoL-4D, as well as an RA-specific instrument,the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI), were administered to assess patients' HRQoL. The Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) was used by doctors to measure patients' clinical activity. Multivariable linear regression was used to compare patients' HRQoL across different levels of activity. Spearman's correlation was used to assess the correlation between doctor-reported clinical activity and HRQoL.
A total of 314 patients with RA participated in this study. The mean score of HAQ-DI was 0.87 (SD: 0.91). Using patients in the clinical remission group as a reference, patients in the moderate and high disease activity groups showed significantly reduced health state utility values and HRQoL scores (all p<0.05). On the contrary, there was an increase in HAQ-DI scores, indicating more impairment (p<0.05). All instruments included in the study tended to differentiate disease activity based on multiple criteria, with scores showing a moderate to strong correlation with RA activity (|r|=0.50 to 0.65). Among them, the disease-specific instrument had the highest correlation.
RA can have considerable impairment on patients' HRQoL, both in terms of physical and psychosocial functioning. Given the strong correlation between clinical activity and HRQoL scores, and the fact that HRQoL can be an important clinical supplement. The EQ-5D-5L is probably the most appropriate generic measurement instrument for measuring HRQoL in RA patients.
本研究旨在全面评估不同活动水平类风湿关节炎（RA）患者的健康相关生活质量（HRQoL），评估临床活动指标与 HRQoL 工具之间的相关性，并分析不同 HRQoL （生理、心理和社会）方面受影响的程度。
横断面、观察性、非干预性研究。
该研究在山东大学齐鲁医院风湿免疫科进行。
2019 年 12 月至 2020 年 10 月，采用便利抽样法共纳入 340 例 RA 患者参与调查。采用 EQ-5D-5L、SF-12 和 AQoL-4D 三种通用量表以及斯坦福健康评估问卷残疾指数（HAQ-DI）等 RA 特异性量表评估患者的 HRQoL。医生采用疾病活动评分 28-红细胞沉降率（DAS28-ESR）评估患者的临床活动。采用多变量线性回归比较不同活动水平患者的 HRQoL。采用 Spearman 相关分析评估医生报告的临床活动与 HRQoL 的相关性。
共 314 例 RA 患者参与本研究。HAQ-DI 的平均评分为 0.87（SD：0.91）。以临床缓解组患者为参照，中、高度疾病活动组患者的健康状态效用值和 HRQoL 评分明显降低（均 P<0.05）。相反，HAQ-DI 评分升高，表明功能障碍加重（P<0.05）。研究中纳入的所有量表均倾向于根据多项标准区分疾病活动，评分与 RA 活动呈中度至强相关（|r|=0.50 至 0.65）。其中，疾病特异性量表相关性最高。
RA 会对患者的 HRQoL 造成相当大的损害，包括生理和心理社会功能。鉴于临床活动与 HRQoL 评分之间的强相关性，以及 HRQoL 可能是重要的临床补充，EQ-5D-5L 可能是评估 RA 患者 HRQoL 的最合适的通用测量工具。
