Jessica L Fairley, Dylan Hansen, Susanna Proudman, Joanne Sahhar, Gene-Siew Ngian, Jennifer Walker, Diane Apostolopoulos, Lauren V Host, Wendy Stevens, Mandana Nikpour, Laura Ross
{"title":"系统性硬化症患者HAQ-DI评分与身体功能恶化的临床关系","authors":"Jessica L Fairley, Dylan Hansen, Susanna Proudman, Joanne Sahhar, Gene-Siew Ngian, Jennifer Walker, Diane Apostolopoulos, Lauren V Host, Wendy Stevens, Mandana Nikpour, Laura Ross","doi":"10.1177/23971983251360883","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Functional disability is a major concern for individuals with systemic sclerosis (SSc). The Health Assessment Questionnaire-Disability Index (HAQ-DI) measures the ability to perform activities of daily living, with higher scores indicating poorer function.</p><p><strong>Objective: </strong>To define the frequency and clinical associations of minimum clinically important difference (MCID) change in HAQ-DI scores in SSc.</p><p><strong>Methods: </strong>Australian Scleroderma Cohort Study participants with two or more HAQ-DI scores ⩽ 2 visits apart were included. Generalised estimating equations were used to model the correlates of the MCID improvement (-0.125 points) and MCID worsening (+0.14 points) of HAQ-DI scores. Subgroup analysis in those with incident (⩽5 years SSc duration at recruitment) and diffuse SSc (dcSSc) were performed.</p><p><strong>Results: </strong>Of 1117 participants, 712 (64%) recorded worsening of HAQ-DI scores. Of 827 participants with baseline HAQ-DI ⩾ 0.125 units, 585 (71%) had recorded improvement. Across 3229 study visits, older age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.1-1.1, <i>p</i> < 0.01), higher skin score (OR 1.1, 95% CI 1.0-1.2, <i>p</i> = 0.01), digital ulcers (OR 1.3, 95% CI 1.0-1.5, <i>p</i> = 0.02), raised C-reactive protein (CRP; OR 1.3, 95% CI 1.1-1.6, <i>p</i> < 0.01) and patient-reported worsening Raynaud's phenomenon (RP; OR 1.2, 95% CI 1.0-1.4, <i>p</i> = 0.04) and dyspnoea (OR 1.3, 95% CI 1.1-1.6, <i>p</i> < 0.01) were associated with worsening of HAQ-DI scores. In those with incident SSc, raised CRP and patient-reported worsening RP and dyspnoea were associated with worsening of HAQ-DI scores. In dcSSc, only raised CRP was associated with worsening HAQ-DI scores, while in lcSSc higher baseline HAQ-DI score, older age, higher skin score, proximal weakness and worsening dyspnoea were associated with worsening scores. Only higher baseline HAQ-DI score was associated with improvement in HAQ-DI scores in the overall cohort (OR 1.3, 95% CI 1.2-1.5, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Two-thirds of a large SSc cohort demonstrated significant change in physical function. Worsening symptom burden and elevated CRP were important determinants of worsening function.</p>","PeriodicalId":17036,"journal":{"name":"Journal of Scleroderma and Related Disorders","volume":" ","pages":"23971983251360883"},"PeriodicalIF":1.2000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367724/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical associations of worsening physical function as measured by HAQ-DI scores in systemic sclerosis.\",\"authors\":\"Jessica L Fairley, Dylan Hansen, Susanna Proudman, Joanne Sahhar, Gene-Siew Ngian, Jennifer Walker, Diane Apostolopoulos, Lauren V Host, Wendy Stevens, Mandana Nikpour, Laura Ross\",\"doi\":\"10.1177/23971983251360883\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Functional disability is a major concern for individuals with systemic sclerosis (SSc). The Health Assessment Questionnaire-Disability Index (HAQ-DI) measures the ability to perform activities of daily living, with higher scores indicating poorer function.</p><p><strong>Objective: </strong>To define the frequency and clinical associations of minimum clinically important difference (MCID) change in HAQ-DI scores in SSc.</p><p><strong>Methods: </strong>Australian Scleroderma Cohort Study participants with two or more HAQ-DI scores ⩽ 2 visits apart were included. Generalised estimating equations were used to model the correlates of the MCID improvement (-0.125 points) and MCID worsening (+0.14 points) of HAQ-DI scores. Subgroup analysis in those with incident (⩽5 years SSc duration at recruitment) and diffuse SSc (dcSSc) were performed.</p><p><strong>Results: </strong>Of 1117 participants, 712 (64%) recorded worsening of HAQ-DI scores. Of 827 participants with baseline HAQ-DI ⩾ 0.125 units, 585 (71%) had recorded improvement. Across 3229 study visits, older age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.1-1.1, <i>p</i> < 0.01), higher skin score (OR 1.1, 95% CI 1.0-1.2, <i>p</i> = 0.01), digital ulcers (OR 1.3, 95% CI 1.0-1.5, <i>p</i> = 0.02), raised C-reactive protein (CRP; OR 1.3, 95% CI 1.1-1.6, <i>p</i> < 0.01) and patient-reported worsening Raynaud's phenomenon (RP; OR 1.2, 95% CI 1.0-1.4, <i>p</i> = 0.04) and dyspnoea (OR 1.3, 95% CI 1.1-1.6, <i>p</i> < 0.01) were associated with worsening of HAQ-DI scores. In those with incident SSc, raised CRP and patient-reported worsening RP and dyspnoea were associated with worsening of HAQ-DI scores. In dcSSc, only raised CRP was associated with worsening HAQ-DI scores, while in lcSSc higher baseline HAQ-DI score, older age, higher skin score, proximal weakness and worsening dyspnoea were associated with worsening scores. Only higher baseline HAQ-DI score was associated with improvement in HAQ-DI scores in the overall cohort (OR 1.3, 95% CI 1.2-1.5, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Two-thirds of a large SSc cohort demonstrated significant change in physical function. Worsening symptom burden and elevated CRP were important determinants of worsening function.</p>\",\"PeriodicalId\":17036,\"journal\":{\"name\":\"Journal of Scleroderma and Related Disorders\",\"volume\":\" \",\"pages\":\"23971983251360883\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-08-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367724/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Scleroderma and Related Disorders\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/23971983251360883\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Scleroderma and Related Disorders","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/23971983251360883","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Clinical associations of worsening physical function as measured by HAQ-DI scores in systemic sclerosis.
Background: Functional disability is a major concern for individuals with systemic sclerosis (SSc). The Health Assessment Questionnaire-Disability Index (HAQ-DI) measures the ability to perform activities of daily living, with higher scores indicating poorer function.
Objective: To define the frequency and clinical associations of minimum clinically important difference (MCID) change in HAQ-DI scores in SSc.
Methods: Australian Scleroderma Cohort Study participants with two or more HAQ-DI scores ⩽ 2 visits apart were included. Generalised estimating equations were used to model the correlates of the MCID improvement (-0.125 points) and MCID worsening (+0.14 points) of HAQ-DI scores. Subgroup analysis in those with incident (⩽5 years SSc duration at recruitment) and diffuse SSc (dcSSc) were performed.
Results: Of 1117 participants, 712 (64%) recorded worsening of HAQ-DI scores. Of 827 participants with baseline HAQ-DI ⩾ 0.125 units, 585 (71%) had recorded improvement. Across 3229 study visits, older age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.1-1.1, p < 0.01), higher skin score (OR 1.1, 95% CI 1.0-1.2, p = 0.01), digital ulcers (OR 1.3, 95% CI 1.0-1.5, p = 0.02), raised C-reactive protein (CRP; OR 1.3, 95% CI 1.1-1.6, p < 0.01) and patient-reported worsening Raynaud's phenomenon (RP; OR 1.2, 95% CI 1.0-1.4, p = 0.04) and dyspnoea (OR 1.3, 95% CI 1.1-1.6, p < 0.01) were associated with worsening of HAQ-DI scores. In those with incident SSc, raised CRP and patient-reported worsening RP and dyspnoea were associated with worsening of HAQ-DI scores. In dcSSc, only raised CRP was associated with worsening HAQ-DI scores, while in lcSSc higher baseline HAQ-DI score, older age, higher skin score, proximal weakness and worsening dyspnoea were associated with worsening scores. Only higher baseline HAQ-DI score was associated with improvement in HAQ-DI scores in the overall cohort (OR 1.3, 95% CI 1.2-1.5, p < 0.01).
Conclusions: Two-thirds of a large SSc cohort demonstrated significant change in physical function. Worsening symptom burden and elevated CRP were important determinants of worsening function.
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