Correlates of the disability index of the health assessment questionnaire: A measure of functional impairment in systemic sclerosis

Philip J. Clements, Weng Kee Wong, Eric L. Hurwitz, Daniel E. Furst, Maureen Mayes, Barbara White, Fredrick Wigley, Michael Weisman, Walter Barr, Larry Moreland, Thomas A. Medsger, Virginia Steen, Richard Martin, David Collier, Arthur Weinstein, Edward Lally, John Varga, Steven Weiner, Brian Andrews, Micha AbelesJames Seibold

Research output: Contribution to journalArticlepeer-review

108 Scopus citations


Objective. To evaluate functional impairment in systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma at the time of entry into a trial of a therapeutic intervention (D-penicillamine). Methods. The 20-item Disability Index of the Health Assessment Questionnaire (HAQ-DI) was administered to 134 patients as they entered a multicenter trial of high-dose versus low-dose D-penicillamine. All patients had diffuse SSc of <18 months' duration. SSc patients who had severe organ system involvement and recent renal crisis and who were receiving prednisone > 10 mg/day were excluded from entry. Logistic regression modeling was used to examine the relationship of HAQ-DI scores to SSc skin and organ system involvement. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to estimate effects. Results. The mean (±SD) HAQ-DI score at entry was 1.04 ± 0.67. Fifty-three percent of patients had HAQ-DI scores ≥1.0 (signifying moderate-to-severe functional impairment). Multivariate logistic regression demonstrated that impaired fist closure ≥23 mm (OR 4.24, 95% CI 1.68-10.70), reduced handspread ≤175 mm (OR 4.5, 95% CI 1.80-11.24), joint tenderness count ≥1.0 (OR 2.93, 95% CI 1.16- 7.40), age ≥43 years (OR 2.44, 95% CI 1.01-5.95), platelet count ≥330,000/mm3 (OR 2.30, 95% CI 0.96-5.57), and female sex (OR 2.43, 95% CI 0.77-7.73) were the most important correlates of HAQ-DI scores ≥1.0. Conclusion. Increased HAQ-DI scores at baseline were correlated with reduced fist closure, reduced handspread, elevated platelet count, presence of tender joints, older age, and female sex. The most important contributor to functional impairment was hand dysfunction. Even within the first 18 months after SSc onset, moderate-severe functional impairment (HAQ-DI scores ≥1.0) was frequent (53%) in this group of diffuse SSc patients. In early diffuse SSc, the self-administered HAQ-DI is therefore a valuable assessment of function that correlates with objective physical and laboratory measures of SSc disease involvement. Abnormal HAQ-DI scores may support patient claims of functional impairment, help to focus physician attention on implementing measures to reduce functional impairment, and be useful in reflecting the disease course overtime.

Original languageEnglish (US)
Pages (from-to)2372-2380
Number of pages9
JournalArthritis and rheumatism
Issue number11
StatePublished - Nov 1999

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)


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