Background/Purpose: The independency is one of the major concerns according to patients’ perspective. For instance, independency is top ranking problem in psoriatic arthritis patients and it take part in  PsA core set domain (1).   The objectives of this study were to assess level of independency and its correlation with disease activity.

Methods: Patents with inflammatory arthritis were consecutively recruited. Age, sex, disease duration, education level, DMARD usage were recorded. Independency was assessed with visual activity scale (VAS)-independence (0-100 mm) according to patients’ perspective. VAS – independence more than 40/100 mm were defined as "dependent patient". All patients were assessed with patient global assessment (PGA), physician global assessment (PhGA), pain VAS, fatigue VAS, swollen (66 joints), and tender joint counts (68 joints). Other measures were BASDAI, BASFI, ASDAS-CRP, DAS-28, SDAI, CDAI, and HAQ. Correlation of outcome measures with independence-VAS were calculated.     

Results: Total 194 (66% female) patients (88 RA, 87 AS, 19 PsA) were enrolled to study. Mean age was 47.1±12 years-old and mean disease duration was 9.5 (7.8) years. 83 (42.8%) patients had less or equal than 5 years educational level and 104 (53.6%) patients had regular occupations. 88 (45.4%) patients were used biological DMARD. Independence-VAS score was zero in 141 (72.6%) patients and 28 patients (14.4%) had more or equal than 40 mm independence VAS score. Female patients were more frequently dependent than male patients (19.5% vs 4.5%, p=0.005). There was no difference at age, disease duration, incoming, occupation, disease type, biological DMARD usage according to dependence status. Dependent patients had worst disease activity and functional status (Table 1). Correlation of independence-VAS with other outcome measures were followed; HAQ (r=0.70), BASFI (r=0.64), BASDAI (r=0.58), PhGA (r=0.57), pain-VAS (0.57), PGA (r=0.52), CDAI (r=0.51), ASDAS-CRP (r=0.51), SDAI (r=0.48), fatigue-VAS (r=0.46),DAS-28 (r=0.42), TJC-68 joints (r=0.39), SJC-66 joints (r=0.27). 

Conclusion: Being independenct is a major goal according to patients’ perspective. Independency is closely related with functional disability and disease activity. However, when assessed with VAS score, a floor effect can be seen. For inflammatory arthritis patients, we need a well-defined instruments for the assessment of independence.

Reference:

1. Orbai AM et al. Ann Rheum Dis. 2016;76:673-680.

Table 1: Independence level and disease activity scores