Session Type: Poster Session (Monday)
Session Time: 9:00AM-11:00AM
Background/Purpose: The HAQ disability index (HAQ-DI) is the most widely used disease-specific measure of physical disability in RA. This study explores the sensitivity to change of 3 scoring methods of the HAQ-DI in relation to disease activity in active RA patients.
Methods: Patient data was extracted from an international RA database, the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology (METEOR) database. All adult patients fulfilling the 2010 ACR/EULAR RA classification criteria with complete data with respect to the 20 questions of the HAQ-DI and components of the DAS28 (4 variable) using the ESR (DAS28-ESR(4)) for 2 visits at least 6 – 12 months apart with high disease activity at visit 1, (DAS28-ESR(4) > 5.1) were included in the study. Three scoring methods of the HAQ-DI: 1) the conventional method (HAQ-8), 2) the Tomlin method (HAQ-T) and 3) the 20-item method (HAQ-20) were analysed against the EULAR response criteria dichotomized for good/moderate response group versus the no response group. The proportion of patients achieving the minimally clinical important difference (MCID) of the HAQ-DI was compared in the EULAR responder and non-responder groups. Logistic regression analysis was used to determine independent predictors of achieving a minimally clinical important improvement (MCII) (improvement in HAQ-DI ≥ 0.22) of the HAQ-DI.
Results: Of the 5 539 patients in the METEOR database at the time of data extraction, 421 patients met the inclusion criteria. The mean age (SD) and disease duration (SD) of this cohort of patients were 55.0 (13) years and 10.5 (9.5) years respectively at visit 1. The median DAS28-ESR(4) (IQR) declined from 5.9 (5.4-6.6) to 5.2 (3.7-6.0) over a mean period (SD) of 8.7 (1.9) months and 47 % of patients had a good/moderate EULAR response. Median HAQ-8 (IQR) improved from 1.6 (1.1-2.1) to 1.4 (0.9-1.9); median HAQ-T (IQR) improved from 1.2(0.7-1.6) to 0.7 (0.4-1.4) and median HAQ-20 improved from 1.2 (0.8-1.6) to 0.9 (0.5-1.4) with similar effect sizes. All three scoring methods showed good agreement. The proportion of patients who achieved the MCII of the HAQ-DI was significantly higher in the EULAR good/moderate response group (64%) compared to the EULAR no response group (11%). The strongest independent predictor of achieving a MCII of the HAQ-DI is EULAR response. The odds of achieving a MCII of the HAQ-8 is 7.11 higher if a good/moderate EULAR response is achieved compared to having no response.
Conclusion: The 3 methods performed similarly in assessing sensitivity to change with no particular advantage using alternative methods of scoring compared to the conventional method of scoring the HAQ-DI. By achieving a good or moderate EULAR response over 60% of RA patients with long-standing disease can attain a clinically significant improvement in their physical function.
To cite this abstract in AMA style:Winchow L, Govind N, Musenge E, Chopra A, Huizinga T, Tikly M. A Comparison of Convergent Validity and Sensitivity to Change of the Conventional Scoring Method to Alternative Scoring Methods of the Health Assessment Questionnaire in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/a-comparison-of-convergent-validity-and-sensitivity-to-change-of-the-conventional-scoring-method-to-alternative-scoring-methods-of-the-health-assessment-questionnaire-in-rheumatoid-arthritis/. Accessed June 3, 2020.
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