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

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Objective. To identify baseline prognostic factors of one year disability within a contemporary early inflammatory arthritis inception cohort and then develop a clinically useful tool which may support early patient education and decision making.

Methods. The Scottish Early Rheumatoid Arthritis (SERA) inception cohort is a prospective multicentre study of newly presenting RA and undifferentiated arthritis patients. SERA data were analysed to determine baseline predictors of disability (defined as a Health Assessment Questionnaire [HAQ] score ≥ 1) at one year. Clinical and psychosocial baseline exposures were submitted to 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 one year. These were independently predicted by baseline disability (OR 2.67; 95%CI 1.98 – 3.59), depression (2.52; 1.18 – 5.37), anxiety (2.37; 1.33 – 4.21), in paid employment with absenteeism during the last week (1.19; 0.63 – 2.23), not in paid employment (2.36; 1.38 – 4.03) and being overweight (1.61; 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 over-fit (p=0.31).

Conclusion. In the context of modern early inflammatory arthritis treatment paradigms, predictors of one year disability appear to be dominated by psychosocial rather than more traditional clinical measures. This alludes to the potential benefit of early access to non-pharmacological interventions targeting key psychosocial factors such as mental health and work disability.
Original languageEnglish
Pages (from-to)1596-1602
Number of pages7
JournalArthritis & Rheumatology
Issue number7
Early online date24 Jun 2016
Publication statusPublished - Jul 2016

Bibliographical note

Supported by the Translational Medicine Research Collaboration (award INF-GU-168), a consortium made up of the Universities of Aberdeen, Dundee, Edinburgh, and Glasgow, the 4 associated NHS Health Boards (Grampian, Tayside, Lothian, and Greater Glasgow & Clyde), and Pfizer, and by the Chief Scientific Office (award Ref ETM-40).


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