Ceiling effects of the health assessment questionnaire and its modified version in some ambulatory rheumatoid arthritis patients

Article Abstract:

The modified version of the Health Assessment Questionnaire (MHAQ) does not appear to do as good a job as the HAQ at reflecting clinical improvement among patients with relatively mild cases of rheumatoid arthritis (RA). The MHAQ is a shortened version of the HAQ, which measures degree of functional disability. Fifty-six patients who were affected by RA were administered the HAQ, which incorporated the questions of the MHAQ, and answers were analyzed for each version. Patients were also evaluated physically. One year later the HAQ was re-administered and a physical assessment was repeated. Patients were white, and two-thirds were college graduates. HAQ scores at one year generally correlated well with improvements or declines in clinical parameters. Only 7% of patients failed to show improved HAQ scores despite improved clinical signs. Conversely, MHAQ scores correlated relatively poorly with clinical change. About 18% of MHAQ scores failed to reflect clinical improvement.

Methods, Disability evaluation

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Radiological progression in rheumatoid arthritis: how many patients are required in a treatment trial to test disease modification?

Article Abstract:

Patient selection is one of the most important factors in planning clinical trials of different treatments for rheumatoid arthritis (RA). Many of these studies use sequential X-ray films to examine erosion of cartilage in RA patients. A study estimated the number of patients that should be enrolled in clinical trials that use sequential X-ray films to examine RA progression. Clinical trials were done at two arthritis study centers in North America and three in Europe that examined the progression of radiological damage to fingers and wrists in RA patients. The evaluation of radiological damage was reliable for sequential films from the same patient over a 1/2 to two-year period. It was estimated that 153 patients would be needed in each study group for a reliable evaluation of RA treatment.

Planning, Clinical trials, Medical research

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The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic

Article Abstract:

Fibromyalgia does not appear to be a discrete disorder but rather a continuum of varying degrees of pain and tender points. This was the conclusion of a study of 627 patients seen at a rheumatology clinic. All were assessed for fatigue, pain, functional disability and number of tender points. Symptoms varied with the number of tender points and patients with fewer than 11 tender points had symptoms. Eleven tender points is the traditional cutoff point for diagnosing fibromyalgia. Dolorimetry, which measures the threshold of pain at various sites, had no relation to symptoms.

Diagnosis, Fibromyalgia

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