The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis

Abstract

Clinical measurement in rheumatoid arthritis (RA) has focused on articular problems. Although measures like the Health Assessment Questionnaire (HAQ) are widely used to determine functional impairment, there is a need to determine the overall effect of RA on general health status. We evaluated the relationship of a generic health status measure - the Nottingham Health Profile (NHP) - to the clinical, laboratory and radiological changes in the EULAR core data set for RA. Two hundred consecutive out-patients with RA were recruited. Their mean age was 58.9 yr and mean disease duration 11.3 yr. Patients completed the NHP and the following assessments were made: the EULAR Core Data Set, the duration of morning stiffness, the Disease Activity Score (DAS), rheumatoid factor (RF) levels, and Larsen's score for X-rays of hands and wrists. RA patients had higher scores on the NHP than both a random population sample and a second sample of patients with a variety of common diseases. NHP scores were not related to age or disease duration in RA. There was little relationship between perceived distress and the Larsen score, RF, ESR and C-reactive protein levels. Moderate associations were seen between NHP scores and disease activity measures, including the number of tender and swollen joints, pain and the duration of early morning stiffness, and also with a disability measure - the HAQ. NHP scores were highly related to disease activity measured by DAS. High DAS scores were associated with high scores in the energy level, pain and sleep sections of the NHP. The NHP gives relevant information about RA patients. They have high scores for pain, physical mobility and energy level sections, and also have high distress for sleep and emotional reactions.