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American Journal of Medical and Biological Research. 2013, 1(4), 91-94
DOI: 10.12691/ajmbr-1-4-1
Open AccessArticle

Validity of Health Assessment Questionnaire Disability Index (HAQDI) for Assessing Disease Activity in Iraqi Patients with Active Rheumatoid Arthritis

Ehab Mudher Mikhael1, and Faiq Isho Gorial2

1Pharmacy College, University of Baghdad, Baghdad, Iraq

2Medicine College, University of Baghdad, Baghdad, Iraq

Pub. Date: August 08, 2013

Cite this paper:
Ehab Mudher Mikhael and Faiq Isho Gorial. Validity of Health Assessment Questionnaire Disability Index (HAQDI) for Assessing Disease Activity in Iraqi Patients with Active Rheumatoid Arthritis. American Journal of Medical and Biological Research. 2013; 1(4):91-94. doi: 10.12691/ajmbr-1-4-1


Objective: Rheumatoid arthritis is a common autoimmune disease associated with many complications like joint damage, disability and even death. It requires early and aggressive treatment with regular follow up to ensure safety and effectiveness of treatment for the patients. Disease activity score of 28 joints (DAS28) and simplified disease activity index (SDAI) are common tools that used to assess disease activity, whereas health assessment questionnaire disability index (HAQDI) is a patient reported tool for assessing patient functional ability. This study aimed to evaluate the effectiveness of HAQDI score for monitoring disease activity and response to therapy in Iraqi patients with active rheumatoid arthritis. Methods: A cross-sectional study was conducted in Baghdad Teaching Hospital, Rheumatology out patient Unit from August 2011 to May 2012. A total of 95 patients (21 males and 74 females) with active RA were involved in this study. Disease activity was measured by DAS28 and the SDAI whereas functional status of the patients was measured using HAQDI score. Results: There was a significant positive correlation of HAQDI score with clinical parameters like swelling joint count (SJC), tender joint count (TJC), visual analogue scale (VAS), physician global assessment (EGA) and morning stiffness. Additionally HAQDI was significantly correlated with disease activity scores DAS28 and SDAI. Furthermore it correlated with inflammatory markers ESR and CRP. HAQDI score was better correlated with clinical parameters in patients with high disease activity than those with moderate activity. Conclusion: HAQDI score is a valid and useful tool to monitor disease activity and response to treatment in Iraqi patients with highly active RA.

rheumatoid arthritis disease activity disability HAQDI

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[1]  Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular manifestations in rheumatoid arthritis. Maedica (Buchar) 2010; 5:286-91.
[2]  Schneeberger EE, Citera G, Maldonado Cocco JA, Salcedo M, Chiardola F, Rosemffet MG, Marengo MF,Papasidero S, Chaparro Del Moral R, Rillo OL, Bellomio V, Lucero E, Spindler A, Berman A, Duartes Noe D, Barreira JC, Lázaro MA, Paira SO. Factors associated with disability in patients with rheumatoid arthritis. J Clin Rheumatol. 2010 Aug;16(5):215-8.
[3]  Prete M, Racanelli V, Digiglio L, Vacca A, Dammacco F, Perosa F. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmun Rev. 2011 Dec; 11(2):123-31. doi: 10.1016/j.autrev.2011.09.001. Epub 2011 Sep 10.
[4]  Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, Combe B, Cutolo M, de Wit M, Dougados M, Emery P, Gibofsky A, Gomez-Reino JJ, Haraoui B, Kalden J, Keystone EC, Kvien TK,McInnes I, Martin-Mola E, Montecucco C, Schoels M, van der Heijde D; T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631-7. doi: 10.1136/ard.2009.123919. Epub 2010 Mar 9.
[5]  Roy Fleischmann. Don’t forget traditional DMARDs. Rheumatology 2011;50:429-430.
[6]  Mary Anne Koda-Kimble, Young L Y, Kradjan WA and Guglielmo BJ. Applied therapeutics: the clinical use of drugs. 9th edn; Philadelphia: Wolters KluwerHealth/Lippincott Williams & Wilkins 2009; CH 43:1-44.
[7]  Young A, Dixey J, Cox N, Davies P, Devlin J, Emery P, Gallivan S, Gough A, James D, Prouse P, Williams P, Winfield J. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS). Rheumatology (Oxford). 2000 Jun;39(6):603-11.
[8]  Farheen K, Agarwal SK. Assessment of disease activity and treatment outcomes in rheumatoid arthritis. J Manag Care Pharm. 2011 Nov-Dec;17(9 Suppl B):S09-13.
[9]  Mitchell K. shared care - the way forward for patient oriented follow up care in rheumatoid arthritis. Rheumatology 2000;39:457-58.
[10]  Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-8.
[11]  Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, van Riel PL, Tugwell P. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 2003; 42:244-57.
[12]  Alchy EM, Gorial FI, Majeed IA, Hussain SA. Validity of simplified disease activity index using CRP titer in comparison to disease activity score-28 joints in Iraqi patients with active Rheumatoid arthritis. J Exp Integr Med. 2012; 2(3): 231-236.
[13]  Bruce B, Fries JF. The Stanford health assessment questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol 2003; 30:167-78.
[14]  Ghosh A, Ghosh B, Pain S, Pande A, Saha S, Banerjee A, Biswas AB. Comparison between DAS28, CDAI and HAQ-DI as tools to monitor early rheumatoid arthritis patients in eastern India. Indian Journal of Rheumatology 2011; 30(6): 116-122.
[15]  National Committee for Clinical Laboratory Standards (NCCLS). Reference and Selected Procedure for the Erythrocyte Sedimentation Rate (ESR) Test; Approved Standard - Fourth Edition. NCCLS document H2-A4, Wayne, PA, USA 2000.
[16]  Philip AG, Andrews PA. Rapid determination of C-reactive protein levels: semi-quantitative versus quantitative. Clin Lab Observ 1986; 110:263-5.
[17]  Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S100-8.
[18]  Singer, J.M. C.M., Plotz, E. Parker & S.K. Elster. Amer. J. Clin. Path 1957;28: 611.
[19]  Altınkesen E, Gelecek N. Functional status and quality of life in patients with early and late stage rheumatoid arthritis. Fizyoter Rehabil. 2011;22(2):93-99.
[20]  Alvarez-Hernández E, Peláez-Ballestas I, Vázquez-Mellado J, Terán-Estrada L, Bernard-Medina AG,Espinoza J, Aceves-Avila FJ, Goycochea-Robles MV, Garza M, Ventura L, Burgos-Vargas R;REUMAIMPACT. Validation of the Health Assessment Questionnaire disability index in patients with gout. Arthritis Rheum. 2008 May 15;59(5):665-9. doi: 10.1002/art.23575.
[21]  Drossaers-Bakker KW, De Buck M, Van Zeben D, Zwinderman AH, Breedveld FC, Hazes JMW. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheumat 1999; 42: 1854-60.
[22]  Bensen, William, Choquette, Denis, Baker, Milton F., Otawa, Susan M., Khalil, Hayssam; Identification of Four Parameters That Drive the Discordance Between the Patient and Physician Global Assessment in Rheumatoid Arthritis [abstract]. Arthritis Rheum 2012;64 Suppl 10 :2108.
[23]  Garneau KL, Iversen MD, Tsao H, Solomon DH. Primary care physicians' perspectives towards managing rheumatoid arthritis: room for improvement. Arthritis Res Ther. 2011;13(6):R189. doi: 10.1186/ar3517. Epub 2011 Nov 18.
[24]  Scott DL, Pugner K, Kaarela K, Doyle DV, Woolf A, Holmes J, Hieke K. The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford). 2000 Feb;39(2):122-32.
[25]  Cho SK, Sung YK, Choi CB, Cha HS, etal. Do patients with elderly - onset rheumatoid arthritis have severe functional disability?. Semin Arthritis Rheum. 2012 Aug;42(1):23-31. doi: 10.1016/j.semarthrit.2012.02.004. Epub 2012 Mar 31.