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Impaired mobility drives disability in psoriatic arthritis – An observational study from Karnataka Psoriatic Arthritis Cohort (KPsAC)

1 Department of Clinical Immunology and Rheumatology, St. John's Medical College Hospital, Bengaluru, India
2 Chanre Rheumatology and Immunology Research Centre, Bengaluru, India
3 Columbia Asia Hospital, Bengaluru, India
4 Arthritis Specialty Clinic, Hubli, India
5 Department of Rheumatology, Manipal Hospitals, Bengaluru, India
6 Vikram Hospital, Bengaluru, India
7 Narayana Health City, Bengaluru, India
8 Sakra Hospital, Bengaluru, India
9 SDM Medical College, Dharwad, India
10 JSS Medical College, Mysore, India
11 Yenepoya Specialty Hospital, Managlore, India
12 Department of Rheumatology, Apollo Hospital, Bengaluru, India
13 Department of Clinical Immunology and Rheumatology, Mahaveer Jain Hospital, Bengaluru, India
14 Department of Rheumatology, Aster CMI Hospital, Bengaluru, India
15 Apollo BGS Hospital, Mysore, India
16 Fortis Hospital, Bengaluru, India
17 Sparsh Hospital, Bengaluru, India
18 Samarpan Health Centre, Bengaluru, India

Correspondence Address:
Vineeta Shobha,
Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, Sarjapur Road, Bengaluru - 560 034, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_285_21

Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease with significant functional impairment. Health Assessment Questionnaire-Disability Index (HAQ-DI) is a reliable and validated outcome measure for a variety of arthritides including PsA. Objective: The objective of this study was to assess the disability as an outcome measure in PsA using the Indian version of HAQ (I-HAQ). Methods: The I-HAQ was administered to PsA patients diagnosed as per the Classification Criteria for PsA. The I-HAQ comprises 12 questions (nine basic and three advanced activities of daily living (ADLs), on the standard HAQ format) relevant to the Indian population. Results: In the 549 participants, the mean I-HAQ was 0.31 (0.45) and 48.2% had mild-to-moderate disability (I-HAQ>0–1). Female gender, older age, higher skin, joint scores, and Disease Activity Index for PsA were associated with some disability (I-HAQ>0). Symmetric polyarthritis (0.34) and spondyloarthritis (0.32) had a significantly higher disability compared to other subsets. Analyzing the individual questions of I-HAQ, squatting in the toilet or sitting cross-legged on the floor (r = 0.78), walking 3 km (r = 0.77), and climbing a flight of stairs (r = 0.74) correlated maximally to the total I-HAQ. ADL which was affected most frequently was “climbing a flight of stairs.” I-HAQ was significantly lower in patients who had been on disease-modifying antirheumatic drugs for 6 months or more (P = 0.0001). Conclusions: The Indian version of HAQ-DI could be efficiently employed to assess outcomes in our cohort. Nearly half of the cohort had mild-to-moderate disability suggesting a high burden of inflammation. Higher joint activity scores are strongly associated with disability.

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