OBJECTIVE: To evaluate functional impairment in systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma at the time of entry into a trial of a therapeutic intervention (D-penicillamine). METHODS: The 20-item Disability Index of the Health Assessment Questionnaire (HAQ-DI) was administered to 134 patients as they entered a multicenter trial of high-dose versus low-dose D-penicillamine. All patients had diffuse SSc of < 18 months' duration. SSc patients who had severe organ system involvement and recent renal crisis and who were receiving prednisone > 10 mg/day were excluded from entry. Logistic regression modeling was used to examine the relationship of HAQ-DI scores to SSc skin and organ system involvement. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to estimate effects. RESULTS: The mean (+/-SD) HAQ-DI score at entry was 1.04 +/- 0.67. Fifty-three percent of patients had HAQ-DI scores > or = 1.0 (signifying moderate-to-severe functional impairment). Multivariate logistic regression demonstrated that impaired fist closure > or = 23 mm (OR 4.24, 95% CI 1.68-10.70), reduced handspread < or = 175 mm (OR 4.5, 95% CI 1.80-11.24), joint tenderness count > or = 1.0 (OR 2.93, 95% CI 1.16-7.40), age > or = 43 years (OR 2.44, 95% CI 1.01-5.95), platelet count > or = 330,000/mm3 (OR 2.30, 95% CI 0.96-5.57), and female sex (OR 2.43, 95% CI 0.77-7.73) were the most important correlates of HAQ-DI scores > or = 1.0. CONCLUSION: Increased HAQ-DI scores at baseline were correlated with reduced fist closure, reduced hand-spread, elevated platelet count, presence of tender joints, older age, and female sex. The most important contributor to functional impairment was hand dysfunction. Even within the first 18 months after SSc onset, moderate-severe functional impairment (HAQ-DI scores > or = 1.0) was frequent (53%) in this group of diffuse SSc patients. In early diffuse SSc, the self-administered HAQ-DI is therefore a valuable assessment of function that correlates with objective physical and laboratory measures of SSc disease involvement. Abnormal HAQ-DI scores may support patient claims of functional impairment, help to focus physician attention on implementing measures to reduce functional impairment, and be useful in reflecting the disease course over time.
OBJECTIVE: To evaluate functional impairment in systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma at the time of entry into a trial of a therapeutic intervention (D-penicillamine). METHODS: The 20-item Disability Index of the Health Assessment Questionnaire (HAQ-DI) was administered to 134 patients as they entered a multicenter trial of high-dose versus low-dose D-penicillamine. All patients had diffuse SSc of < 18 months' duration. SSc patients who had severe organ system involvement and recent renal crisis and who were receiving prednisone > 10 mg/day were excluded from entry. Logistic regression modeling was used to examine the relationship of HAQ-DI scores to SSc skin and organ system involvement. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to estimate effects. RESULTS: The mean (+/-SD) HAQ-DI score at entry was 1.04 +/- 0.67. Fifty-three percent of patients had HAQ-DI scores > or = 1.0 (signifying moderate-to-severe functional impairment). Multivariate logistic regression demonstrated that impaired fist closure > or = 23 mm (OR 4.24, 95% CI 1.68-10.70), reduced handspread < or = 175 mm (OR 4.5, 95% CI 1.80-11.24), joint tenderness count > or = 1.0 (OR 2.93, 95% CI 1.16-7.40), age > or = 43 years (OR 2.44, 95% CI 1.01-5.95), platelet count > or = 330,000/mm3 (OR 2.30, 95% CI 0.96-5.57), and female sex (OR 2.43, 95% CI 0.77-7.73) were the most important correlates of HAQ-DI scores > or = 1.0. CONCLUSION: Increased HAQ-DI scores at baseline were correlated with reduced fist closure, reduced hand-spread, elevated platelet count, presence of tender joints, older age, and female sex. The most important contributor to functional impairment was hand dysfunction. Even within the first 18 months after SSc onset, moderate-severe functional impairment (HAQ-DI scores > or = 1.0) was frequent (53%) in this group of diffuse SSc patients. In early diffuse SSc, the self-administered HAQ-DI is therefore a valuable assessment of function that correlates with objective physical and laboratory measures of SSc disease involvement. Abnormal HAQ-DI scores may support patient claims of functional impairment, help to focus physician attention on implementing measures to reduce functional impairment, and be useful in reflecting the disease course over time.
Authors: Peter A McSweeney; Richard A Nash; Keith M Sullivan; Jan Storek; Leslie J Crofford; Roger Dansey; Maureen D Mayes; Kevin T McDonagh; J Lee Nelson; Theodore A Gooley; Leona A Holmberg; C S Chen; Mark H Wener; Katherine Ryan; Julie Sunderhaus; Ken Russell; John Rambharose; Rainer Storb; Daniel E Furst Journal: Blood Date: 2002-09-01 Impact factor: 22.113
Authors: Beth Wallace; Suzanne Kafaja; Daniel E Furst; Veronica J Berrocal; Peter A Merkel; James R Seibold; Maureen D Mayes; Dinesh Khanna Journal: Rheumatology (Oxford) Date: 2015-02-09 Impact factor: 7.580
Authors: Richard A Nash; Peter A McSweeney; Leslie J Crofford; Muneer Abidi; Chien-Shing Chen; J David Godwin; Theodore A Gooley; Leona Holmberg; Gretchen Henstorf; C Fred LeMaistre; Maureen D Mayes; Kevin T McDonagh; Bernadette McLaughlin; Jerry A Molitor; J Lee Nelson; Howard Shulman; Rainer Storb; Federico Viganego; Mark H Wener; James R Seibold; Keith M Sullivan; Daniel E Furst Journal: Blood Date: 2007-04-23 Impact factor: 22.113
Authors: Manjit K Singh; Philip J Clements; Daniel E Furst; Paul Maranian; Dinesh Khanna Journal: Arthritis Care Res (Hoboken) Date: 2012-02 Impact factor: 4.794
Authors: Kathryn S Torok; Nancy A Baker; Mary Lucas; Robyn T Domsic; Robert Boudreau; Thomas A Medsger Journal: Clin Exp Rheumatol Date: 2010-06-10 Impact factor: 4.473
Authors: Jason C Cole; Dinesh Khanna; Philip J Clements; James R Seibold; Donald P Tashkin; Harold E Paulus; Michael R Irwin; Sarosh J Motivala; Daniel E Furst Journal: Qual Life Res Date: 2006-07-07 Impact factor: 4.147
Authors: D Khanna; D E Furst; R D Hays; G S Park; W K Wong; J R Seibold; M D Mayes; B White; F F Wigley; M Weisman; W Barr; L Moreland; T A Medsger; V D Steen; R W Martin; D Collier; A Weinstein; E V Lally; J Varga; S R Weiner; B Andrews; M Abeles; P J Clements Journal: Ann Rheum Dis Date: 2006-03-15 Impact factor: 19.103