Brief Report: Predicting Functional Disability: One-Year Results From the Scottish Early Rheumatoid Arthritis Inception Cohort

Caroline Kronisch, David J. McLernon, James Dale, Caron Paterson, Stuart H. Ralston, David M. Reid, Ann Tierney, John Harvie, Neil McKay, Hilary E. Wilson, Robin Munro, Sarah Saunders, Ruth Richmond, Derek Baxter, Mike McMahon, Vinod Kumar, John McLaren, Stefan Siebert, Iain B. McInnes, Duncan PorterGary J. Macfarlane, Neil Basu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To identify baseline prognostic indicators of disability at 1 year within a contemporary early inflammatory arthritis inception cohort and then develop a clinically useful tool to support early patient education and decision-making. Methods: The Scottish Early Rheumatoid Arthritis (SERA) inception cohort is a multicenter, prospective study of patients with newly presenting RA or undifferentiated arthritis. SERA data were analyzed to determine baseline predictors of disability (defined as a Health Assessment Questionnaire [HAQ] score of ≥1) at 1 year. Clinical and psychosocial baseline exposures were entered into a forward stepwise logistic regression model. The model was externally validated using newly accrued SERA data and subsequently converted into a prediction tool. Results: Of the 578 participants (64.5% female), 36.7% (n = 212) reported functional disability at 1 year. Functional disability was independently predicted by baseline disability (odds ratio [OR] 2.67 [95% confidence interval (95% CI) 1.98, 3.59]), depression (OR 2.52 [95% CI 1.18, 5.37]), anxiety (OR 2.37 [95% CI 1.33, 4.21]), being in paid employment with absenteeism during the last week (OR 1.19 [95% CI 0.63, 2.23]), not being in paid employment (OR 2.36 [95% CI 1.38, 4.03]), and being overweight (OR 1.61 [95% CI 1.04, 2.50]). External validation (using 113 newly acquired patients) evidenced good discriminative performance with a C statistic of 0.74, and the calibration slope showed no evidence of model overfit (P = 0.31). Conclusion: In the context of modern early inflammatory arthritis treatment paradigms, predictors of disability at 1 year appear to be dominated by psychosocial rather than more traditional clinical measures. This indicates the potential benefit of early access to nonpharmacologic interventions targeting key psychosocial factors, such as mental health and work disability.

Original languageEnglish
Pages (from-to)1596-1602
Number of pages7
JournalArthritis & Rheumatology
Volume68
Issue number7
Early online date11 Feb 2016
DOIs
Publication statusPublished - 1 Jul 2016

Fingerprint Dive into the research topics of 'Brief Report: Predicting Functional Disability: One-Year Results From the Scottish Early Rheumatoid Arthritis Inception Cohort'. Together they form a unique fingerprint.

Cite this