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Measuring health status in psoriatic arthritis: the Health Assessment Questionnaire & its modification

  [ 28 votes ]   [ Discuss This Article ]
www.ProHealth.com • May 5, 1995


OBJECTIVE. The Health Assessment Questionnaire (HAQ) has proven to
be a reliable and valid measure of outcome for a variety of
arthritides. A recent modification of HAQ for
spondyloarthropathy (HAQ-S) has also been reported. Our
purpose was to evaluate the HAQ and HAQ-S as outcome measures
in the assessment of patients with psoriatic arthritis (PsA).


METHODS. The HAQ, including HAQ-S was administered to all
patients attending our Psoriatic Arthritis Clinic between June
and December, 1993. Clinical and radiological assessments were
performed according to a standard protocol that measures
disease activity, fibrositic tender points (TP), disease
severity and damage. Analysis was performed using SAS for the
PC.

RESULTS. The patient population included 114 patients, 70
men and 44 women with a mean age of 49.3 years and a mean
arthritis duration of 15.1 years. The mean HAQ score was 0.50,
while the mean HAQ-S score was 0.53 (scores range 0 to 3 for
this instrument). The overall HAQ and HAQ-S disability scores
were highly correlated with several clinical measures of
function, including grip strength (r = -0.63 and -0.59,
respectively). American College of Rheumatology functional
class (r = 0.59 and 0.60, respectively), as well as the number
of fibrositic TP (r = 0.54 and 0.57, respectively). These
disability scores also correlated highly with the overall
number of actively inflamed joints (r = 0.49 and 0.50,
respectively); however, they correlated only moderately or
poorly with other measures of disease activity such as morning
stiffness, total number of joint effusions, erythrocyte
sedimentation rate (ESR) and the PASI score for psoriasis and
with all measures of disease severity. A similar pattern of
correlations was found between the individual subscales of the
HAQ and HAQ-S and the clinical measures of function, activity,
and severity, as well as between the pain scale and the
various clinical measures. However, the correlations are
generally lower.

CONCLUSION. Our data suggest that HAQ and
HAQ-S capture clinical measures of function and pain in PsA
but do not correlate with disease severity. The HAQ and its
modification for spondyloarthropathy may reflect fibromyaglia
as a measure of pain and tenderness in these patients. Thus,
the clinical assessment of disease activity and both clinical
and radiological assessments of joint damage remain important
outcome measures in PsA.

Blackmore MG, Gladman DD, Husted J, Long JA, Farewell VT




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