Background/Purpose:

 In treating rheumatoid arthritis (RA), patient’s activity in daily life (ADL) is extremely important factor, because RA is chronic inflammatory disease that leads discomfort or disability in ADL in natural. In RA treatment, patient is usually interviewed and evaluated. Health assessment questionnaire (HAQ) is common index for ADL. In general, HAQ is thought to be influenced by disease activity and structural damage, thus it consists of activity related HAQ (ACT-HAQ) and damage related HAQ (DAM-HAQ). It is widely accepted in rheumatologist. However, HAQ often results in unexpected. It is more frequently seen in elderly patient, that even joint deformity is minimum and disease activity is well controlled. We have been thinking that HAQ is not only with ACT-HAQ and DAM-HAQ, but other factors have affected on HAQ. Aging is candidate for HAQ influencing factor. We have evaluated effect of aging on HAQ.

Methods:

 579 RA patients had been treated more than 1 year in our clinic. In these, 257 patients who have been treated consecutively for more than three years had been recruited for analysis in this study. These patients have been consulted in one to three months interval, and have been evaluated their disease activity as twenty-eight joints disease activity score with C-reactive protein (DAS28-CRP), daily activity as HAQ disability index (HAQ-DI), and radiographic evaluation with Sharp/van der Heijde score (SHS) from X-ray pictures of bilateral hands and feet have been taken at first, and mostly one year period. HAQ-DI, DAS28-CRP, SHS, and age at first (@BL), and average value of these indices in follow up (@F) were calculated for every patient, and relationship between HAQ-DI@F, and each of other indices had been evaluated statistically with single regression analysis. Then relationship between HAQ-DI@F and every other index had evaluated with multiple regression analysis.

 In additional, patients were classified according to Age@F, whether less than sixty-five (G-Y) or not (G-O). HAQ-DI@F, DAS28-CRP@F, and SHS@F of the two groups were compared statistically with ANOVA. Relationship between age and HAQ@F were statistically evaluated with linear regression analysis for each age group.

Results:

 All indices but DAS28-CRP@BL demonstrated significant positive relationship with HAQ-DI@F (p < 0.0001) in single regression analysis, and for multiple regression analysis, every index has demonstrated significant positive relationship between HAQ-DI@F.

 In ANOVA study, G-O demonstrated significantly higher HAQ-DI in both @BL and @F (p < 0.0001), although no significant difference have demonstrated for other indices. Age@F demonstrated significant positive correlation with HAQ@F in G-O (p < 0.0001), although in G-Y there have shown no significant correlation.

Conclusion:

 These results suggested that HAQ-DI is not consisted only with ACT-HAQ and DAM-HAQ. HAQ@BL has extremely strong influence on HAQ-DI thereafter, and at the same time, age is also very important factor that determines HAQ-DI. For the reason, elderly patients tend to diminish HAQ-DI reduction by disease activity control. In treating RA, we need to consider patient’s age to make optimal results for treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/age-related-disability-in-daily-life-should-be-considered-in-older-than-sixty-five-year-old-rheumatoid-arthritis-patient/