Early functional disability predicts both all cause and
cardiovascular mortality in people with inflammatory
polyarthritis: results from the Norfolk Arthritis
Register
Tracey M Farragher 1, Mark Lunt 1, Diane K Bunn 2, Alan J Silman 1 and Deborah P M Symmons 1*
1 The University of Manchester, United Kingdom
2 Norfolk and Norwich University Hospital, United Kingdom
* To whom correspondence should be addressed. E-mail: deborah.symmons{at}manchester.ac.uk.
Accepted 30 October 2006
 | Abstract |
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Objective:To investigate the predictive value of
early functional disability in patients with
inflammatory polyarthritis (IP), for all cause and
cardiovascular (CVD) mortality.
Methods:1,010 subjects with new onset IP from the
Norfolk Arthritis Register were studied. All were seen
at baseline and one-year. Health Assessment
Questionnaire (HAQ) scores were obtained at both time-
points. Vital status at 10 years from registration was
established via central records. Mortality rates (all
cause and CVD) per 1,000 person years were calculated by
HAQ stratum (HAQ scores <1, 1 to 2, 
2). The
predictive value of HAQ (per unit increase) at the two
time-points, adjusted for age at symptom onset, gender,
and other factors found to predict mortality, was
assessed using Cox regression models. The analysis was
repeated for those who satisfied the 1987 ACR criteria
for rheumatoid arthritis (RA) by 5 years.
Results:By 10 years, 171 (16.9%) subjects had
died. 89 deaths (52%) were attributed to CVD. Mortality
rates were greatest in the highest HAQ group at both
time-points. Following adjustment for other predictors,
HAQ score at year 1 remained a significant predictor of
all cause mortality (HR 1.46; 95% CI 1.15, 1.85) and CVD
mortality (HR 1.49; 95% CI 1.12, 1.97). The predictive
value of HAQ at year 1 was similar in the RA subgroup.
Conclusions:Our data show that; at one year of
follow-up, HAQ score is an important independent
predictor of subsequent all cause and CVD mortality in
people with IP and RA. Baseline HAQ scores are of less
value.
Keywords:
cardiovascular mortality, functional disability, inflammatory polyarthritis, outcome, premature mortality
