The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma: Results from an analysis of two randomized controlled trials in early diffuse scleroderma

N. Sultan, Janet E. Pope, P. J. Clements, D. E. Furst, J. R. Siebold, W. K. Wong, N. Bellamy, M. Mayes, M. Baron, B. White, M. Ellman, Fredrick Wigley, S. Carette, M. H. Weismann, C. D. Smith, W. Barr, I. M. Chalmers, L. W. Moreland, T. A. Medsger, P. HongV. Steen, D. O'Hanlon, R. W. Martin, E. Kaminska, D. Collier, J. Markland, E. Lally, J. Sibley, J. Varga, L. Catoggio, S. Weiner, B. Andrews, M. Abeles

Research output: Contribution to journalArticle

Abstract

Objective. Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes. Methods. We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20% improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as % predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine). Results. A baseline HAQ disability score of less than the median was predictive of at least a 20% improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P <0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment. Conclusion. A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.

Original languageEnglish (US)
Pages (from-to)472-478
Number of pages7
JournalRheumatology
Volume43
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

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Diffuse Scleroderma
Randomized Controlled Trials
Health
Penicillamine
Skin
Methotrexate
Surveys and Questionnaires
Physicians
Age Factors
Pain Measurement
Rheumatoid Arthritis
Odds Ratio
Morbidity

Keywords

  • Early diffuse scleroderma
  • Good outcome
  • HAQ
  • Prognosis

ASJC Scopus subject areas

  • Neuroscience(all)
  • Rheumatology

Cite this

The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma : Results from an analysis of two randomized controlled trials in early diffuse scleroderma. / Sultan, N.; Pope, Janet E.; Clements, P. J.; Furst, D. E.; Siebold, J. R.; Wong, W. K.; Bellamy, N.; Mayes, M.; Baron, M.; White, B.; Ellman, M.; Wigley, Fredrick; Carette, S.; Weismann, M. H.; Smith, C. D.; Barr, W.; Chalmers, I. M.; Moreland, L. W.; Medsger, T. A.; Hong, P.; Steen, V.; O'Hanlon, D.; Martin, R. W.; Kaminska, E.; Collier, D.; Markland, J.; Lally, E.; Sibley, J.; Varga, J.; Catoggio, L.; Weiner, S.; Andrews, B.; Abeles, M.

In: Rheumatology, Vol. 43, No. 4, 04.2004, p. 472-478.

Research output: Contribution to journalArticle

Sultan, N, Pope, JE, Clements, PJ, Furst, DE, Siebold, JR, Wong, WK, Bellamy, N, Mayes, M, Baron, M, White, B, Ellman, M, Wigley, F, Carette, S, Weismann, MH, Smith, CD, Barr, W, Chalmers, IM, Moreland, LW, Medsger, TA, Hong, P, Steen, V, O'Hanlon, D, Martin, RW, Kaminska, E, Collier, D, Markland, J, Lally, E, Sibley, J, Varga, J, Catoggio, L, Weiner, S, Andrews, B & Abeles, M 2004, 'The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma: Results from an analysis of two randomized controlled trials in early diffuse scleroderma', Rheumatology, vol. 43, no. 4, pp. 472-478. https://doi.org/10.1093/rheumatology/keh070
Sultan, N. ; Pope, Janet E. ; Clements, P. J. ; Furst, D. E. ; Siebold, J. R. ; Wong, W. K. ; Bellamy, N. ; Mayes, M. ; Baron, M. ; White, B. ; Ellman, M. ; Wigley, Fredrick ; Carette, S. ; Weismann, M. H. ; Smith, C. D. ; Barr, W. ; Chalmers, I. M. ; Moreland, L. W. ; Medsger, T. A. ; Hong, P. ; Steen, V. ; O'Hanlon, D. ; Martin, R. W. ; Kaminska, E. ; Collier, D. ; Markland, J. ; Lally, E. ; Sibley, J. ; Varga, J. ; Catoggio, L. ; Weiner, S. ; Andrews, B. ; Abeles, M. / The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma : Results from an analysis of two randomized controlled trials in early diffuse scleroderma. In: Rheumatology. 2004 ; Vol. 43, No. 4. pp. 472-478.
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abstract = "Objective. Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes. Methods. We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20{\%} improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as {\%} predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine). Results. A baseline HAQ disability score of less than the median was predictive of at least a 20{\%} improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P <0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment. Conclusion. A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.",
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author = "N. Sultan and Pope, {Janet E.} and Clements, {P. J.} and Furst, {D. E.} and Siebold, {J. R.} and Wong, {W. K.} and N. Bellamy and M. Mayes and M. Baron and B. White and M. Ellman and Fredrick Wigley and S. Carette and Weismann, {M. H.} and Smith, {C. D.} and W. Barr and Chalmers, {I. M.} and Moreland, {L. W.} and Medsger, {T. A.} and P. Hong and V. Steen and D. O'Hanlon and Martin, {R. W.} and E. Kaminska and D. Collier and J. Markland and E. Lally and J. Sibley and J. Varga and L. Catoggio and S. Weiner and B. Andrews and M. Abeles",
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TY - JOUR

T1 - The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma

T2 - Results from an analysis of two randomized controlled trials in early diffuse scleroderma

AU - Sultan, N.

AU - Pope, Janet E.

AU - Clements, P. J.

AU - Furst, D. E.

AU - Siebold, J. R.

AU - Wong, W. K.

AU - Bellamy, N.

AU - Mayes, M.

AU - Baron, M.

AU - White, B.

AU - Ellman, M.

AU - Wigley, Fredrick

AU - Carette, S.

AU - Weismann, M. H.

AU - Smith, C. D.

AU - Barr, W.

AU - Chalmers, I. M.

AU - Moreland, L. W.

AU - Medsger, T. A.

AU - Hong, P.

AU - Steen, V.

AU - O'Hanlon, D.

AU - Martin, R. W.

AU - Kaminska, E.

AU - Collier, D.

AU - Markland, J.

AU - Lally, E.

AU - Sibley, J.

AU - Varga, J.

AU - Catoggio, L.

AU - Weiner, S.

AU - Andrews, B.

AU - Abeles, M.

PY - 2004/4

Y1 - 2004/4

N2 - Objective. Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes. Methods. We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20% improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as % predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine). Results. A baseline HAQ disability score of less than the median was predictive of at least a 20% improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P <0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment. Conclusion. A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.

AB - Objective. Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes. Methods. We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20% improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as % predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine). Results. A baseline HAQ disability score of less than the median was predictive of at least a 20% improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P <0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment. Conclusion. A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.

KW - Early diffuse scleroderma

KW - Good outcome

KW - HAQ

KW - Prognosis

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