1. Anti-TNF therapy improves hand function in rheumatoid arthritis
within 3 months
D Hull1, C Ball1, and S Abraham Kennedy Institute of Rheumatology, University of Oxford 2 Department of Medicine, Imperial College London
BACKGROUND
Hands and wrists are affected in 80-90% of patients with RA resulting in pain and reduced hand function thus impacting on quality of life.
Anti-TNF therapy has revolutionised RA treatment but its effect on hand function has not been recorded to date using specific measures.
The Health Assessment Questionnaire (HAQ) is not specific and lacks of sensitivity to subtle changes in function.
The Michigan Hand Outcomes Questionnaire (MHQ) has been shown to be a reliable and sensitive measure of hand function and is validated for use in RA patients.
RESULTS
16 RA patients: 12 females and 4 males, mean age 55.8 years
Mean DAS28 score pre-treatment 5.29, reducing to 3.62 at 3 months after treatment initiation
There was a significant improvement in overall MHQ score (p=0.0038) at 3 months
MHQ sub-scores of function, work, hand pain and satisfaction improved significantly
Improvement in overall MHQ score correlated significantly (r=0.82, p<0.0001) with change in DAS28 score at 3 months post start of treatment
METHODS
16 patients with RA were assessed using MHQ before and at 3 months after starting anti-TNF treatment.
Treatment response was assessed by DAS28 (CRP) score.
Data from MHQ domains were analysed by comparing baseline and 3 months post treatment using Student’s paired t test.
Correlations between MHQ scores and DAS28 scores assessed using Spearman rank.
r=0.82
P<0.0001
DISCUSSION
Treatment with anti-TNF in our cohort of 16 patients with RA significantly improved hand function as measured by MHQ within 3 months of commencing treatment.
Improvement of hand function in this group correlated with overall improvement in their inflammatory status as shown by the DAS28 score
The MHQ is a useful additional tool for measuring aspects of treatment. It is easy to administer, can identify change within 3 months and could be used clinically alongside other widely used measures such as DAS28 to monitor treatment response in RA. A B A B C D C D
The Michigan Hand Outcomes Questionnaire (MHQ)
37-item questionnaire with 6 domains giving scores for: function, activities of daily living (ADL), pain, work, aesthetics and satisfaction
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