PMID- 27158777
OWN - NLM
STAT- MEDLINE
DCOM- 20170719
LR  - 20211204
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 69
IP  - 2
DP  - 2017 Feb
TI  - Trends in Functional Disability and Determinants of Clinically Meaningful Change 
      Over Time in Hispanic Patients With Rheumatoid Arthritis in the US.
PG  - 294-298
LID - 10.1002/acr.22924 [doi]
AB  - OBJECTIVE: To identify determinants of clinically meaningful change in functional 
      disability in low-income Hispanic patients with established rheumatoid arthritis 
      (RA) in the US. METHODS: We evaluated 156 low-socioeconomic status, uninsured, 
      largely immigrant Hispanic patients, collectively described as vulnerable 
      patients, on 3 consecutive visits (baseline, 6, and 12 months followup) at a 
      single center. Disability (Health Assessment Questionnaire [HAQ] disability index 
      [DI]), pain (visual analog scale), and depression (Patient Health Questionnaire 
      [PHQ-9]) were assessed each time. Disease activity (Disease Activity Score in 28 
      joints [DAS28] using the erythrocyte sedimentation rate), serology results, 
      radiographs, treatments, and irreversible articular damage were also recorded. 
      RESULTS: At baseline, 71% had significant disability (HAQ DI >1), and 34% were 
      depressed. HAQ DI improved significantly over time (P = 0.032), and absence of 
      depression (PHQ-9 <10), lower pain, lack of erosions, and no biologic agent use 
      at baseline all predicted the greatest improvement (P < 0.001). Baseline to 
      12-month HAQ DI recovery exceeding the minimum clinically important difference 
      (MCID) occurred in 42% of patients. Recovery was associated with concurrent 
      improvements in DAS28, pain, and PHQ-9 scores (albeit below their respective 
      MCIDs), as well as with absence of erosions. Notably, isolated shifts in PHQ-9 or 
      pain scores over MCID were sufficient to yield clinically meaningful HAQ DI 
      changes. CONCLUSION: Results suggest that disease activity, depression, and pain 
      are modifiable parameters with consistent, significant, independent, and additive 
      contributions to HAQ DI changes across the disease trajectory in vulnerable 
      Hispanic patients with RA. Their improvement over time, collectively or in 
      isolation, may yield clinically measurable improvements in functional disability 
      and reaffirms these parameters as actionable items in a patient-centered 
      treat-to-target approach.
CI  - (c) 2016, American College of Rheumatology.
FAU - Karpouzas, George A
AU  - Karpouzas GA
AD  - Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los 
      Angeles, California.
FAU - Draper, Taylor
AU  - Draper T
AD  - David Geffen School of Medicine, University of California at Los Angeles.
FAU - Moran, Rosalinda
AU  - Moran R
AD  - Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los 
      Angeles, California.
FAU - Hernandez, Elizabeth
AU  - Hernandez E
AD  - Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los 
      Angeles, California.
FAU - Nicassio, Perry
AU  - Nicassio P
AD  - David Geffen School of Medicine, University of California at Los Angeles.
FAU - Weisman, Michael H
AU  - Weisman MH
AD  - Cedars Sinai Medical Center, Los Angeles, California.
FAU - Ormseth, Sarah
AU  - Ormseth S
AUID- ORCID: 0000-0002-0565-5255
AD  - Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los 
      Angeles, California.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Antirheumatic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antirheumatic Agents/therapeutic use
MH  - Arthritis, Rheumatoid/*complications/drug therapy/psychology
MH  - Depression/epidemiology/etiology
MH  - *Disability Evaluation
MH  - Female
MH  - Hispanic or Latino
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Poverty
MH  - United States
EDAT- 2016/05/10 06:00
MHDA- 2017/07/20 06:00
CRDT- 2016/05/10 06:00
PHST- 2015/09/08 00:00 [received]
PHST- 2016/03/22 00:00 [revised]
PHST- 2016/04/19 00:00 [accepted]
PHST- 2016/05/10 06:00 [pubmed]
PHST- 2017/07/20 06:00 [medline]
PHST- 2016/05/10 06:00 [entrez]
AID - 10.1002/acr.22924 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2017 Feb;69(2):294-298. doi: 10.1002/acr.22924.