Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Impact of Morning Stiffness on Quality of Life in Early Rheumatoid Arthritis.
Britsemmer, Karin, van Schaardenburg, Dirkjan
In early rheumatoid arthritis (RA), joint stiffness and pain are often most severe in the morning hours. Morning stiffness (MS) could impair physical functioning and may impact the quality of life (QoL). The aim of this study was to evaluate the relationship between MS and QoL.
Data of 286 patients (71% female, age 53 (13)) fulfilling the ACR 1987 criteria for RA either at baseline or at 1 year follow-up that had data available were used for the analysis. Patients were treated with conventional DMARDs or TNF-a inhibitors as prescribed by the treating rheumatologist. Univariate and multivariate correlation/regression was used to evaluate the relationship between MS and QoL, and between MS and physical functioning, with disease activity as covariate. MS was expressed as duration in minutes, disease activity was measured by the 28-joint count disease activity score (DAS28) and the Health Assessment Questionnaire (HAQ) measured physical functioning. EuroQol measured quality of life, expressed as visual analog scale (VAS, range 0100) and as profile result. Profiles were calculated according to a scoring formula based on unweighted coefficient (range -0.59 1,00)1. Measurements were at baseline and after 1-year follow-up. Statistical tests were performed at a one-sided alpha of 0.05, given the known relationship of patient symptoms with quality of life, the moderate discriminative characteristics of both duration of MS and EuroQol as measure, and the relative low power of regression models to detect interaction effects. Thus all results with a p<0.10 are regarded as significant.
At baseline 84% of patients had MS of 15 minutes or more (mean 79 (69) minutes). Patients had active disease with a mean DAS28 of 5,0 (1.2) and were significantly impaired in physical functioning (mean HAQ 1.21 (0,73)). Quality of life was significantly impacted with EuroQol profile scores of 0,37 (0,29) and VAS results of 55 (20). Most patients had improved scores after 1-year (table 1). In univariate analysis MS was significantly correlated to EuroQol at both time points. More importantly, improvement in MS correlated strongly with improvement in EuroQol. This relationship maintained when adjusted for DAS28 for the separate time points, but weakened for the change scores. In all models MS was strongly correlated to HAQ even after adjustment for DAS28 (table 1).
Table 1. Descriptives (mean (SD)) and the measures of correlation (adjusted for DAS) between morning stiffness and quality of life
MS is a frequent feature of early RA. It has an impact on quality of life and physical function that is independent of disease activity. Interventions directed at reduction of MS may have added value.
To cite this abstract, please use the following information:
Britsemmer, Karin, van Schaardenburg, Dirkjan; The Impact of Morning Stiffness on Quality of Life in Early Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2127