Health Assessment Questionnaire Predicts All-Cause Mortality at One Year in Patients with Early Rheumatoid Arthritis

Safoora Fatima¹, Orit Schieir², Marie-France Valois³, Susan Bartlett³, Louis Bessette⁴, Gilles Boire⁵, Glen Hazlewood⁶, Carol Hitchon⁷, Edward C Keystone⁸, Diane Tin⁹, Carter Thorne⁹, Vivian Bykerk¹⁰, Janet Pope¹¹ and Canadian Early Arthritis Cohort (CATCH) Investigators¹², ¹University of Western Ontario, London, ON, Canada, ²Canadian Early Arthritis Cohort Study, Montreal, Canada, ³McGill University, Montreal, Canada, ⁴Laval University, Quebec, Canada, ⁵Universite de Sherbrooke, Sherbrooke, Canada, ⁶University of Calgary, Calgary, AB, Canada, ⁷University of Manitoba, Winnipeg, MB, Canada, ⁸Mount Sinai Hospital, Toronto, ON, Canada, ⁹Southlake Regional Health Centre, Newmarket, ON, Canada, ¹⁰Hospital for Special Surgery, New York, NY, ¹¹Department of Medicine, University of Western Ontario, St. Joseph's Health Centre, London, ON, Canada, ¹²Canadian Early Arthritis Cohort (CATCH) Study, Toronto, Canada

Meeting: ACR Convergence 2020

Keywords: Health Assessment Questionnaire (HAQ), Mortality, rheumatoid arthritis

Session Information

Date: Monday, November 9, 2020

Title: RA – Diagnosis, Manifestations, & Outcomes Poster IV: Lifespan of a Disease

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with RA are at greater risk of mortality than the general population. Higher HAQ disability has been associated with hospitalizations and mortality in established RA; whether HAQ disability predicts mortality in early RA (ERA) is unknown.

Methods: Data were from adult early RA patients (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2017; who initiated treatment with 1 or more DMARDs and had completed HAQ data at baseline and 1 year. Descriptive statistics, t-tests and chi-square tests were used to summarize and compare baseline patient characteristics including sociodemographic variables, RA characteristics and comorbidities amongst deceased and non-deceased patients. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations between HAQ at baseline and 1 year, respectively, with all-cause mortality in each year of follow up.

Results: 1724 patients with early RA; mean age 55 years and 72% female were included. Over 10 years, 62 deaths (2.4%) occurred. Deceased patients had higher HAQ scores and DAS28(disease activity) scores at baseline and 1 year versus the non-deceased group. Age, male sex, lower education, smoking, more comorbidities, higher baseline disease activity and steroid use were associated with mortality in unadjusted survival models. Contrary to HAQ at baseline, the association between all-cause mortality and HAQ at 1 year remained significant even after adjusting for age, gender, comorbidities, disease activity, smoking, education, seropositivity, symptom duration and steroid use in adjusted survival models. HAQ baseline unadjusted hazard OR was 1.46 (CI 1.02-2.09) and adjusted 1.25 (CI 0.81-1.94) vs. HAQ at 1 year unadjusted hazard OR was 2.58 (CI 1.78-3.72) and adjusted 1.75 (CI 1.10-2.77).

Conclusion: Higher self-reported disability (high HAQ) at 1 year was significantly associated with all-cause mortality in a large early RA cohort suggesting that poorer disease control and function in the first year of RA contributes to higher mortality.

Disclosure: S. Fatima, None; O. Schieir, None; M. Valois, None; S. Bartlett, Pfizer, 1, UCB, 1, Lily, 1, Novartis, 1, Merck, 1, Janssen, 1, Abbvie, 1; L. Bessette, Amgen, 1, 2, 3, BMS, 1, 2, 3, Janssen, 1, 2, 3, UCB, 1, 2, 3, AbbVie, 1, 2, 3, Pfizer, 1, 2, 3, Merck, 1, 2, 3, Celgene, 1, 2, 3, Sanofi, 1, 2, 3, Lilly, 1, 2, 3, Novartis, 1, 2, 3, Gilead, 2, 6, 8; G. Boire, Amgen, 1, 2, BMS, 1, 2, 3, Celgene, 1, Merck, 1, 2, Pfizer, 1, 2, 3, Eli Lilly, 1, 2, Janssen, 1, Abbvie, 1, Novartis, 1, Sandoz, 1; G. Hazlewood, None; C. Hitchon, Pfizer, 1, UCB Canada, 1; E. Keystone, AbbVie, 2, 5, 8, Celltrion, 2, 5, 8, Eli Lilly, 2, 5, 8, Pfizer Inc, 2, 5, 8, Merck, 2, 5, 8, Sandoz, 2, 5, 8, Samsung Bioepsis, 2, 5, 8, Myriad Autoimmune, 2, 5, 8, Purapharm, 2, 5, 8, Janssen, 2, 5, 8, Sanofi-Genzyme, 2, 5, 8, Amgen, 2, 5, 8, AstraZeneca, 2, 5, 8, Bristol-Myers Squibb, 2, 5, 8, F. Hoffman-La Roche Ltd., 2, 5, 8, Genentech, 2, 5, 8, Gilead, 2, 5, 8, UCB, 2, 5, 8; D. Tin, None; C. Thorne, Abbvie, 1, 2, Amgen, 1, 2, Celgene, 1, 2, CaREBiodam, 1, Centocor, 1, Janssen, 1, Lilly, 1, Medexus/Medac, 1, 2, Merck, 1, Novartis, 1, 2, Pfizer, 1, 2, Sanofi, 1; V. Bykerk, Amgen, 1, BMS, 1, Gilead, 1, Sanofi-Genzyme/Regeneron, 1, Scipher, 1, Pfizer, 1, UCB, 1, NIH, 1; J. Pope, AbbVie, 2, 5, Amgen, 5, 8, Lilly, 2, 5, 8, UCB, 2, 5, 8, Sanofi, 5, 8, Sandoz, 5, 8, Roche, 2, 5, 8, Pfizer, 5, 8, Novartis, 5, 8, Merck, 2, 5, 8, Janssen, 5, 8, Gilead Sciences, Inc., 2, 5, BMS, 2, 5, 8, Abbott, 5, Actelion, 5, AstraZeneca, 5, Bayer, 5, Boehringer Ingelheim, 5, EICOS, 5, Emerald, 5, GlaxoSmithKline, 5, Medexus, 5, Seattle Genetics, 2; C. (CATCH) Investigators, Amgen, 2, Pfizer Canada, 2, Medexus Inc., 2, Eli Lilly Canada, 2, Merck Canada, 2, Sandoz Canada, Biopharmaceuticals, 2, Gilead Sciences Canada, 2, Hoffmann-LaRoche, 2, Janssen Biotech, 2, UCB Canada, 2, Bristol-Myers Squibb Canada, 2, Sanofi Genzyme, 2, AbbVie Corporation, 2.

To cite this abstract in AMA style:

Fatima S, Schieir O, Valois M, Bartlett S, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk V, Pope J, (CATCH) Investigators C. Health Assessment Questionnaire Predicts All-Cause Mortality at One Year in Patients with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/health-assessment-questionnaire-predicts-all-cause-mortality-at-one-year-in-patients-with-early-rheumatoid-arthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-assessment-questionnaire-predicts-all-cause-mortality-at-one-year-in-patients-with-early-rheumatoid-arthritis/