Background/Purpose: HAQ is considered the gold standard for the evaluation of functional capacity in patients with RA, even though it doesn´t focus in any particular anatomical region. With the objective of assessing functional incapacity of the hand in elderly patients with osteoarthritis, Baron et al. (1987) used a modified version of the HAQ which was calculated as the mean value for those categories involving mostly upper extremities and named it ‘HAQUP’. This instrument has not been validated in patients with RA. Given the high prevalence of upper limb involvement in this disease and the lack of useful tools in daily clinical practice targeting the functional capacity of this anatomical sector, the aim of this study was to validate HAQUP in patients with RA.

Methods: Analytical, observational, prospective cross-sectional study. We included consecutive patients ≥ 18 years with diagnosis of RA (ACR/EULAR 2010). Socio-demographic data, characteristics of the disease, disease activity parameters and treatment were recorded. Patients completed the following self-administered questionnaires: HAQ-A (Argentine Spanish Version), HAQUP, Functional Index for Hand OsteoArthritis (FIHOA) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH). In a subgroup of patients, an occupational therapist made an objective evaluation of the functional capacity of upper limbs using the Sequential Occupational Dexterity Assessment (SODA). The reproducibility of the questionnaire was assessed in 30 patients who completed HAQUP in a second visit, 10 to 15 days. Statistical analysis: Population characteristics were described. Reliability was assessed using the Cronbach test. Construct validity was analyzed through the correlation with other functional capacity questionnaires and disease activity parameters using the Spearman coefficient. Reproducibility was estimated using test-retest reliability. A linear regression model was constructed with HAQUP as the outcome variable and those variables that were statistically significant in bivariate analysis.

Results: We included 100 patients, 83% women, mean age 57.9 years (SD 11.6). The median HAQ-A was 0.88 (IQR 0.25-1.50). Cronbach’s alpha test was 0.94. The intra-item correlation did not show redundant questions. HAQUP showed excellent correlation with HAQ-A (r = 0.93); FIHOA (r = 0.89); Quick DASH (r = 0.91) and SODA (r = -0.84). It also showed good correlation with DAS28 (r = 0.68) and other composite disease activity indices as well as with other parameters of the disease [visual analog scale (VAS) for pain, patient and physician global, 28 tender joint count (TJC), 68 TJC, 28 swollen joint count (SJC) and 66 SJC]. There was no correlation between HAQUP and age or disease duration. The reproducibility of the questionnaire was 0.82. Multiple linear regression adjusted for age and sex showed patient global VAS as the main determinant of HAQUP, followed by the presence of morning stiffness and 66 SJC.

Conclusion: HAQUP was found to be reliable, valid and reproducible in patients with RA, representing a useful tool for the evaluation of the functional capacity of the upper limbs in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-the-health-assessment-questionnaire-upper-extremity-haqup-in-patients-with-rheumatoid-arthritis/