Determinants of Disability in Rheumatoid Arthritis: A Community-Based Cohort Study
Megan L. Krause1, Cynthia S. Crowson2, Tim Bongartz4, Eric L. Matteson1, 3, Clement J. Michet1, Thomas G. Mason1, Scott T. Persellin1, Sherine E. Gabriel1, 3, John M. Davis, III*, 1
Identifiers and Pagination:Year: 2015
First Page: 88
Last Page: 93
Publisher ID: TORJ-9-88
Article History:Received Date: 25/6/2015
Revision Received Date: 4/8/2015
Acceptance Date: 28/8/2015
Electronic publication date: 20/11/2015
Collection year: 2015
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Longitudinal care of a community-based cohort of patients with rheumatoid arthritis (RA) was evaluated retrospectively. Candidate determinants of disability included visual analog scales (VAS) for patient global assessment and pain, comorbidities, and medications. The outcome was the ‘patient-acceptable symptom state’ for disability as defined by the Health Assessment Questionnaire (HAQ) disability index, using a cutoff of <1.04. Two-sample t tests and multivariable logistic regression were used to determine odds ratios (OR) for associations between predictor variables and disability. Out of a total of 99 patients, 28 (28%) patients had HAQ ≥1.04 at their last visit. The greatest odds of not attaining the patient-acceptable symptom state in a multivariable model was associated with corticosteroids (OR: 5.1; p=0.02), antidepressants (OR: 5.3; p=0.02), and female sex (OR: 6.5; p=0.05). In the era of biologic therapy, female sex, corticosteroids, and antidepressants remain profound determinants of disability highlighting the need to understand the underlying mechanisms.