Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database,IORRA

Abstract

Objectives Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan.

Methods Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed.

Results Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL).

Conclusions Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.     

The minimally important difference for the Japanese version of the health assessment questionnaire in patients with rheumatoid arthritis in daily practice

Objective: To validate the minimally important difference (MID) of physical function using the Japanese version of the Health Assessment Questionnaire (J-HAQ) in a cohort of rheumatoid arthritis (RA).

Methods: Patients who participated in a cohort study in both October 2008 and April 2009 were analyzed. Patients self-rated their change in overall status over 6 months using a 5-point Likert scale (“much better”, “somewhat better”, “same”, “somewhat worse”, or “much worse”). The MID for J-HAQ score was defined as the mean J-HAQ score change in patients who rated themselves “somewhat better”. An effect size (ES) of 0.2–0.5 was considered to be suitable for MID.

Results: A total of 4560 patients were analyzed. The mean (standard deviation [SD]) MID for J-HAQ score was ?0.06 (0.29), corresponding to an ES of 0.08. As exploratory analysis, 1999 patients with a J-HAQ score?≥0.5 and 28-joint disease activity score (DAS28)?≥?2.6 at baseline were assessed. The mean (SD) MID for J-HAQ score of these patients was 0.13 (0.01), corresponding to an ES of 0.21.

Conclusions: The MID for J-HAQ score was 0.13 in patients with baseline J-HAQ score?≥0.5 and DAS28?≥?2.6. The MID for J-HAQ score was influenced by disease status and functional disability.     

Evaluating the Korean version of the Multidimensional Health Assessment Questionnaire in patients with rheumatoid arthritis

Although the Health Assessment Questionnaire (HAQ) and the Modified Health Assessment Questionnaire are useful tools for assessing and monitoring patients with rheumatic diseases, they have a “floor effect” and do not fully reflect the psychological status of patients. Recently, the Multidimensional Health Assessment Questionnaire (MDHAQ) was developed to overcome these shortcomings. We translated the MDHAQ into the Korean language and evaluated its reliability and validity for use with Korean-speaking patients with rheumatoid arthritis (RA). The questionnaire was translated into the Korean language by three translators, who were aware of its objectives, and it was translated back into the English language by three different translators. One question was modified to reflect Korean culture, and imperial measures were changed to metric measures because most Koreans use the metric system. The Korean MDHAQ was administered to 136 patients with RA who were attending the outpatient rheumatology clinic at the Chonnam National University Hospital (Gwangju, South Korea). Test–retest reliability was assessed in 101 patients after 1 week. To assess criterion validity, we compared MDHAQ scores with HAQ scores and the American College of Rheumatology (ACR) functional class. To test construct validity, the MDHAQ was compared to ACR core criteria (tender and swollen joint count, pain, patient's global assessment, physician's global assessment, erythrocyte sedimentation rate, and C-reactive protein), the Beck Depression Inventory (BDI), and the State–Trait Anxiety Inventory (STAI). The test–retest reliability was analyzed by computing κ statistics, which ranged from 0.60 to 0.76. Cronbach's α coefficient ranged from 0.892 to 0.938. The MDHAQ was significantly correlated with the HAQ and ACR functional class (all p<0.001). The correlations between the MDHAQ scores and the ACR core set, BDI, and STAI were all high and statistically significant. The Korean version of the MDHAQ is a reliable, valid tool for assessing Korean patients with RA.     

Factors associated with functional disability in patients with rheumatoid arthritis

To determine factors associated with functional disability in patients with rheumatoid arthritis (RA). A total of 100 RA patients were reviewed retrospectively. Multiple regression analysis was used to investigate associations between the dependent variable (health assessment questionnaire) and independent variables (age, disease duration, hand grip strength values, VAS and DAS-28 scores). Main factors associated with functional disability were disease activity score as reflected in a high score on the DAS-28 (r = 0.68, p < 0.001) and disease duration (r = 0.23, p < 0.05). Increased age, decreased grip strength and high pain level were associated with lower functional ability, but none of these was a predictor of disability in the regression model. The results indicate that age, disease duration, disease activity, pain intensity and hand grip strength are related to physical disability in patients with RA. However, only disease activity has an impact on physical function. Thus, treatment of RA patients should focus on early inhibition of disease activity in order to achieve a good functional outcome.     

Preferences of Japanese rheumatoid arthritis patients in treatment decision-making

Objectives

We investigated the decision-making preferences of rheumatoid arthritis (RA) patients using two different scales: the Decision Making Preference Scale (DMPS) and the modified Control Preference Scale (CPS). In addition, we evaluated the factors associated with patients’ preferences for decision-making.

Methods

A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 hospitals in Japan. The following variables were investigated: (1) DMPS, which is a subscale of the Autonomy Preference Index, composed of six items; patients responded on a 5-point Likert scale. (2) The modified CPS, in which patients were asked to choose one actual and one desired role in decision-making from among three options (passive role, collaborative role, and active role). (3) Sociodemographic data and RA-specific characteristics. Multivariate analyses were used to assess the relationship between patients’ preferences and selected variables.

Results

The response rate was 58.6 %. There were few patients who wished to make their own decisions when they were hospitalized or illness became worse. However, the majority of patients desired to collaborate with the doctor in making treatment decisions according to the results of modified CPS. The results of modified CPS were significantly associated with the total scores of DMPS. Multivariate analysis demonstrated they younger age and not-housewife were associated with high scores of DMPS.

Conclusions

Patient preferences in decision-making vary at RA outpatient clinic. Physicians need to assess decision-making preferences on an individual basis.     

Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease; utility measures correlate strongly with disease activity measures

Treatment with recombinant human erythropoietin (r-hu-Epo) in patients with rheumatoid arthritis (RA) and anaemia of chronic disease (ACD) resulted in improvement of both anaemia and disease activity. Utilities represent a generic and comprehensive quality of life measure, capable of integrating domain-specific information into one overall value which a patient assigns to his state of health. Therefore, the effect of r-hu-Epo on quality of life was studied by measuring utilities, derived from the rating scale and standard gamble, in a 52-week placebo-controlled randomised double-blind study with r-hu-Epo in 70 patients with active RA and ACD. Furthermore, the relation between anaemia as assessed by haemoglobin levels (Hb), disease activity as assessed with the Disease Activity Score (DAS), and utilities was investigated. Compared to the placebo group, significant improvement of Hb (P<0.001), DAS (P = 0.01) and rating scale utilities (P = 0.002), but not of standard gamble utilities, was observed in the Epo group. Rating scale utilities correlated strongly with DAS (r = –0.47, P<0.01), Hb (r = 0.37, P<0.01) and changes in both DAS (r = –0.74, P<0.01) and Hb (r = 0.44, P<0.01). Both DAS and Hb contributed significantly to the variance in rating scale utilities (21% and 3% respectively) and to changes in rating scale utilities (43% and 3% respectively). Standard gamble utilities correlated less well with clinical disease variables than rating scale utilities did. These results indicate, that r-hu-Epo improves utility-derived health-related quality of life, most probably by improving both disease activity and anaemia. Utilities, particularly rating scale utilities, correlated well with conventional disease activity variables and proved sensitive to change. Utilities may be a useful tool for investigating quality of life in RA-patients. Received: 16 December 1998 / Accepted: 5 March 1999     

Health-related quality of life in rheumatoid arthritis in Northern Sweden: a comparison between patients with early RA, patients with medium-term disease and controls, using SF-36

Living with a chronic disease affects many aspects of an individuals life. The aim of this study was to compare the health-related quality of life, as measured by the SF-36, in patients with early rheumatoid arthritis (RA) at disease onset and after 2 years. The results were furthermore compared with those of patients with medium-term disease and a control group. Forty patients with early RA as well as 39 RA patients with 21–25 years of disease duration and 40 controls were asked to answer the self-administered SF-36 health profile measure. Both patients with early RA and with medium-term disease reported significantly lower values for all eight subscales compared with the controls. At follow-up after 2 years, the patients reported significant improvements on the role physical (RP) and bodily pain (BP) dimensions compared with at disease onset. Physical functioning (PF) was perceived as better in patients with early RA compared with patients who had had the disease for 21–25 years. Women reported significantly higher values for some of the scales than men. In summary, health-related quality of life is negatively affected in early RA as measured by the SF-36. An improvement was implicated after 2 years. There were some gender differences in reported health-related quality of life among patients with early RA, but not in patients with medium-term disease.     

Quality of life evaluated by Short Form-8 in patients with rheumatoid arthritis who were receiving infusion of infliximab

In this study, influences of infliximab to health-related quality of life (HRQOL) and active status of RA were assessed. Between 2003 and 2006, 22 patients with rheumatoid arthritis (RA) began receiving infusion of infliximab. Of all the patients, 17 patients who were followed for at least 30 weeks (102 weeks at maximum) after the start of infliximab were included in this study. The mean age was 54.6 ± 10 years. HRQOL was evaluated with use of the SF-8™, which is a simple version of the Medical Outcome Study Short Form 36. As an index of active status of RA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were collected. CRP and ESR significantly improved at the final follow-up, but RF did not. All subscales of the SF-8 were significantly improved after the start of infliximab. However, there were three patients whose laboratory data were improved, but HRQOL was not. We should not be prepossessed only with laboratory data in treating patients with RA. We recommend that the SF-8 to evaluate HRQOL of patients with RA in busy outpatient clinics because it is both simple and convenient.     

Health‐related quality of life in women with symptomatic hand osteoarthritis: A comparison with rheumatoid arthritis patients,healthy controls,and normative data

Objective

Data on the burden of disease and impact on health‐related quality of life (HRQOL) in hand osteoarthritis (OA) are limited. The goal of this study was to compare HRQOL in patients with hand OA with HRQOL in patients with rheumatoid arthritis (RA), healthy controls, and normative data from the general population.

Methods

A total of 190 women with hand OA were compared with 194 women with RA and 144 healthy women of the same age. Health status was measured using the Short Form 36 (SF‐36), Short Form 6D (SF‐6D), modified Health Assessment Questionnaire (M‐HAQ), pain and fatigue visual analog scales, and grip strength. Scores were compared by analysis of variance and a multivariate analysis of covariance, adjusting for age, number of comorbidities, and years of education. Gaps between patients and population subjects were assessed by calculating S scores on all dimensions of the SF‐36.

Results

Hand OA and RA patients had worse scores on all assessed dimensions of subjective health compared with healthy controls. RA patients showed poorest general health (SF‐36), poorest physical function (M‐HAQ, SF‐36 physical, grip strength), and highest level of fatigue compared with hand OA patients. Hand OA patients reported poorer mental health. Mean utility scores (SF‐6D) in hand OA and RA were 0.64 and 0.63, respectively, with a mean difference compared with healthy controls of 0.13 in hand OA and 0.14 in RA patients. S scores confirmed a marked disparity between individuals with a rheumatic diagnosis (hand OA, RA) and population subjects.

Conclusion

This study illustrates that patients with hand OA experience a broad impact on HRQOL compared with healthy controls. Fatigue and physical function are worse in RA than hand OA.     

Using the health assessment questionnaire to estimate preference‐based single indices in patients with rheumatoid arthritis

Objective

To estimate the relationship between preference‐based measures, EuroQol (EQ‐5D) and SF‐6D, and the Health Assessment Questionnaire (HAQ) disability index (DI) in patients with rheumatoid arthritis (RA), and to characterize components that are predictors of health utility.

Methods

Patients with RA participating in 2 studies in the UK (n = 151) and Canada (n = 319) completed the HAQ, EQ‐5D, and Short Form 36 (SF‐36). The SF‐36, a generic measure of quality of life, was converted into the preference‐based SF‐6D. From these results we developed models of the relationship between the HAQ and SF‐6D and EQ‐5D using various regression analyses.

Results

The optimal model developed for the EQ‐5D entered levels for each item as independent variables (model 5). A root mean square error (RMSE) of 0.18 suggested relatively good predictive ability. For the SF‐6D, RMSEs were lower (0.09), suggesting better predictions than for the EQ‐5D, but models with more explanatory variables did not improve results (model 2 or 4 optimal). The models were able to predict actual SF‐6D and EQ‐5D across the range of the HAQ DI.

Conclusion

Our approach enabled calculations of quality‐adjusted life years from existing trials where only the HAQ was measured. All aspects of the HAQ may not be reflected in the preference‐based measures, and this method is suboptimal to direct measurement of health state utility in clinical trials. Given this limitation, our approach provides an alternative for researchers who need health‐state utility values, but had not included a preference‐based measure in their clinical study because of resource constraints or a desire to limit patient burden.     

Body image in patients with rheumatoid arthritis

Abstract

We investigated body image in patients with rheumatoid arthritis (RA), correlating it with self-esteem, function, and quality of life. Forty-three RA patients and 39 control individuals from the community between 18 and 70 years of age and paired for gender, age, and body mass index (BMI) were evaluated. Patients were assessed for body image [Body Dysmorphic Disorder Examination (BDDE)], self-esteem (Rosenberg Self-Esteem Scale), function [Health Assessment Questionnaire (HAQ)] and quality of life [Short Form-36 (SF-36)]. The RA group had a mean age of 51.6 years, BMI 26.01, and disease duration 12.2 years. Most participants were categorized in functional class I. The BDDE score of the RA group (51.8) was significantly higher than in the control group (22.6) (p < 0.001). Rosenberg Self-Esteem Scale, HAQ and some SF-36 subscales were worse in the RA group than in the control group. These scores had a direct correlation with body image scores (p < 0.001). Individuals with RA had a worse body image than individuals without this condition. Body image was directly correlated with self-esteem, function, and quality of life.     

Evaluation of factors associated with locomotive syndrome in Japanese elderly and younger patients with rheumatoid arthritis

Abstract

Objectives: We aimed to determine the prevalence of locomotive syndrome (LS) using the 25-question geriatric locomotive function scale (GLFS-25) and identify factors associated with LS in elderly and younger patients with rheumatoid arthritis (RA).

Methods: Overall, 390 patients with RA who underwent GLFS-25 measurement, bone mineral density determination, and bioelectrical impedance analysis were enrolled. Factors associated with LS were analyzed by comparing patients with and without LS among both elderly and younger patients with RA.

Results: The prevalence of LS was 41.5%, 47.7% and 32.3% in all patients, elderly patients, and younger patients with RA, respectively. Pain visual analog scale (VAS) and Health Assessment Questionnaire Disability Index (HAQ-DI) were associated with LS in both elderly and younger patients. Moreover, in younger patients with RA, disease activity score in 28 joints (DAS28), erythrocyte sedimentation rate (ESR), basal metabolic rate, and legs muscle mass were identified as being associated with LS.

Conclusion: This study demonstrated that to prevent LS, we should aim to control pain and maintain a low HAQ-DI in elderly and younger patients with RA, and improve disease activity and maintain a higher basal metabolic rate, and legs muscle mass in younger patients with RA.     

High disease activity scores predict the need for additional health services in patients over 60 with rheumatoid arthritis

Objective: To determine whether we meet perceived need, in terms of appropriate supportive health services (physiotherapy, occupational therapy, chiropody and footwear, surgery, education and information), of patients aged 60 years and over with rheumatoid arthritis (RA). Design: A cross‐sectional survey. Participants: 123 patients attending rheumatology outpatient clinics. Results: The response rate was 82% (99/123). Of the respondents 78% had one or more perceived needs. Respondents were more likely to express a need for chiropody or footwear (46%), education about RA (29%), or physiotherapy (22%) than for occupational therapy (7%) or surgery (6%). Further analysis compared this group with the ‘non‐needy’ group. There was a correlation between high disease activity scores and high anxiety scores and greater perceived need for additional health services. Conclusion: There was significant unmet demand for chiropody and footwear, education about RA, physiotherapy, occupational therapy and surgery. It is possible that strategies to reduce anxiety and improve control of active inflammatory disease may reduce demand for supportive services in certain patients. Copyright © 2006 John Wiley & Sons, Ltd.     

Cost-effectiveness of tocilizumab,a humanized anti-interleukin-6 receptor monoclonal antibody,versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study

Abstract

Objectives. To evaluate the cost-effectiveness of tocilizumab in patients with rheumatoid arthritis (RA) in a real-world setting in Japan.

Methods. The cost-effectiveness was determined using a Markov model-based probabilistic simulation. Data from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study between April 2007 and April 2011 were extracted using a pair-matching method: tocilizumab group (n = 104), patients who used at least 1 disease-modifying anti- rheumatic drug and in whom tocilizumab treatment was initiated; methotrexate group (n = 104), patients in whom methotrexate treatment was initiated for the first time or after an interruption of 6 or more months. Assuming a 6-month cycle length, health benefits and costs were measured over a lifetime and discounted at an annual rate of 3%.

Results. Compared with methotrexate treatment, lifetime costs and quality-adjusted life years (QALYs) for tocilizumab treatment were approximately 1.5- and 1.3-times higher, respectively. Incremental cost per QALY gained with tocilizumab was $49,359, which was below the assumed cost-effectiveness threshold of $50,000 per QALY. The probability of tocilizumab being cost- effective was 62.2%.

Conclusion. The simulation model using real-world data from Japan showed that tocilizumab (at a certain price) may improve treatment cost-effectiveness in patients with moderate-to-severe RA by enhancing quality-adjusted life expectancy.     

Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy

Objective: To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T).

Methods: In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (≤3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI)?≤?0.5 or with the delta van der Heijde-modified total Sharp score (ΔvdH-mTSS)?Results: Of 318 patients enrolled, 271 completed the follow-up for 72 weeks and were subjects of the analyses. Factors [odds ratio (95% confidence interval)] significantly associated with the HAQ-DI ≤0.5 were SDAI remission at week 24 [2.99 (1.42–6.28), p?=?0.004], baseline HAQ-DI [0.28 (0.18–0.45), p?=?1.3?×?10^?7], and baseline vdH-mTSS [0.986 (0.976–0.996), p?=?0.009]. A factor associated with ΔvdH-mTSS?p?=?0.002].

Conclusion: Predictive validity of SDAI remission for good outcomes was verified in a T2T-implementing cohort in the current clinical settings.     

Incidence of and risk factors for interstitial pneumonia in patients with rheumatoid arthritis in a large Japanese observational cohort,IORRA

Abstract

Interstitial lung disease (ILD) is a frequently encountered and sometimes life-threatening complication among patients with rheumatoid arthritis (RA). In this study, we aim to clarify the incidence of and risk factors for ILD using a large observational cohort of RA patients. We analyzed the database from a large observational cohort of Japanese RA patients, the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. We defined as interstitial pneumonia (IP) computed tomography (CT) pattern of nonspecific interstitial pneumonia or diffuse alveolar damage. Newly developed IP was identified from patient reports over 2.5 years (April 2004 to October 2006) and was confirmed by extensive medical record, chest X-ray radiograph, and CT. The raw and age/gender-adjusted incidence of IP were reported. IP risk factors were analyzed using a nested case–control design was employed using conditional logistic regression analysis with a stepwise method. Thirty-seven patients among 5,699 RA patients were diagnosed with newly developed IP, including 18 cases with methotrexate-induced pneumonitis (MTX-IP) and 15 cases with IP associated with RA (RA-IP). The age-adjusted incidence of MTX-IP among total patients, males, and females was 3.775, 6.667, and 1.013 per 1,000 cases, respectively, and of RA-IP among total patients, males, and females was 1.056, 1.452, and 0.677 per 1,000 cases, respectively. Conditional logistic regression analysis after stepwise variable selection identified male gender, increased Japanese version of the Health Assessment Questionnaire (J-HAQ) score, decreased pain visual analog scale (VAS), and elevated erythrocyte sedimentation rate as significant risk factors for MTX-IP, while the only risk factor for RA-IP was male gender. The incidence of and risk factors for IP in RA patients were determined in a large observational cohort of RA patients in Japan.     

Clinical utility of the flow cytometric technique for shared rheumatoid epitope

The shared rheumatoid epitope (SRE) on the MHC class II antigen-presenting molecule constitutes a probable genetic risk factor for the occurrence of rheumatoid arthritis (RA) and may also determine disease severity. We have used a novel flow cytometric technique to determine the SRE in over 500 predominantly Caucasian patients attending a general rheumatology clinic. This technique has been validated against a polymerase chain reaction (PCR)/SSO molecular method. The SRE was observed in 90% of patients with Felty's syndrome (n=10) and 75% of patients with RA (n=178) as compared with 39% of patients with osteoarthritis or non-inflammatory rheumatic disorders (n=73). Thus, the SRE determined by this method has a sensitivity for RA of 0.75, a specificity of 0.62 and an estimated positive predictive value of 0.02. In our RA cohort, there was no correlation between the functional outcome (health assessment questionnaire score) and SRE status. In conclusion, the determination of the SRE status by a flow cytometric method was found to have only modest sensitivity and specificity for RA; furthermore, the SRE did not correlate with functional outcomes. The clinical utility of the SRE assay is yet to be defined.     

Post-acute care regains quality of life among middle-aged and older stroke patients in Taiwan

ObjectiveThis study aims to evaluate health-related quality of life (HRQoL) of middle-aged and older stroke patients receiving the stroke post care (PAC) program and to identify possible predictors.Design, setting and participantsThis is a retrospective cohort study. Demographic characteristics and functional outcomes (modified Rankin Scale, Barthel Index, Mini-Mental State Examination, and the Concise Chinese Aphasia Test) were collected at enrollment. EQ-5D HRQoL questionnaires were administered at the beginning and the end of PAC, and health state utilities were compared.ResultsThe EQ-5D utilities of stroke patients aged 75–84 years and 85 years or above were estimated to be 0.091 and 0.159 lower than those aged less than 50 years. A decrease of the utility by 0.075 was observed among patients with the prior history of stroke. The EQ-5D utilities of patients having Barthel Index of 21–40, 41–60, and 61–100 were 0.1432, 0.1568, and 0.1387 higher than those having Barthel Index of 0–20, respectively. For patients reporting extreme problems in self-care or any dimension of EQ-5D questionnaires prior to PAC, increases in utilities by 0.0733 and 0.2875 were noted. The EQ-5D utility of PAC service duration rose by 0.0733 per one incremental day.Conclusions and implicationsThis study provides vital evidence regarding time-varying benefits of PAC services to HRQoL of stroke patients and to identify multiple predictors of HRQoL among stroke patients receiving PAC services. This study thus could serve as good reference to enhance quality of PAC services among stroke patients.     

Health‐related quality of life of patients with psoriatic arthritis: A comparison with patients with rheumatoid arthritis

Objective

To compare health‐related quality of life (QOL) between patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA), using the Medical Outcomes Study Short Form health survey (SF‐36) and the Health Assessment Questionnaire (HAQ).

Methods

Both the SF‐36 and the HAQ were administered to 107 PsA patients attending the University of Toronto Psoriatic Arthritis Clinic between January 1 and December 31, 1994, and to 43 RA patients attending a University of Toronto–affiliated RA clinic during the same period. Standardized assessments of disease activity and severity were also performed at each clinic visit. Logistic regression analysis was used to compare health‐related QOL between PsA and RA.

Results

Both patient populations experienced lower physical health compared with that of a general population sample. The RA patients demonstrated more active inflammatory disease at the time of assessment than the PsA patients. The PsA patients were younger, and more were men. Logistic regression analyses showed that patients with PsA reported higher levels of vitality than patients with RA, even after adjusting for the observed differences in clinical and demographic characteristics. PsA patients, however, reported more role limitations due to emotional problems and more bodily pain after adjusting for the difference in vitality and other covariates.

Conclusions

Although both patient populations experienced reduced QOL, there were some meaningful differences in how the 2 conditions affect health‐related QOL. Further, it appeared that there may be unique disabilities associated with the psoriasis dimension of PsA.