{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:10:43Z","timestamp":1777965043167,"version":"3.51.4"},"reference-count":18,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"unspecified","delay-in-days":83,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018286","name":"Dutch Arthritis Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018286","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["Programma translationeel onderzoek"],"award-info":[{"award-number":["Programma translationeel onderzoek"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["714312"],"award-info":[{"award-number":["714312"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Patients with arthralgia at-risk for rheumatoid arthritis (RA) experience considerable functional disability, though generally less than at RA diagnosis. Secondary prevention trials have shown that treatment can improve disability in patients with arthralgia. However, interpreting the clinical relevancy of the improvements in Health Assessment Questionnaire Disability Index (HAQ-DI) is hampered by the lack of a defined minimal clinically important difference (MCID) in this disease stage. Results from other disciplines than rheumatology suggested that the MCID depends on absolute severity values. Therefore, we hypothesised that the MCID for HAQ-DI in RA depends on absolute values. We aimed to investigate this and, if so, to determine the MCID for disability in the risk setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied the literature and determined the correlation of baseline HAQ-DI and MCID estimates in RA. To determine the MCID in arthralgia, we studied 97 patients treated with methotrexate in the TREAT EARLIER trial with HAQ-DI data at baseline and 12\u2009months. At 12\u2009months, a short-form 36 questionnaire anchor question compared patients\u2019 general health to that of 1 year before. The MCID was determined using the mean change in HAQ-DI score of patients reporting \u2018somewhat better\u2019 and \u2018somewhat worse\u2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In RA, the MCID estimates ranged from \u22120.06 to \u22120.38, and higher absolute HAQ values correlated with a higher MCID. In the at-risk patients studied, the MCID for improvement was \u22120.07\u00b10.28. Likewise, for deterioration, the MCID was +0.05\u00b10.6.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In arthralgia at-risk for RA, the MCID for improvement in HAQ-DI is \u22120.07. This is lower than generally reported in RA. This implies that in arthralgia, compared with RA, smaller improvements in HAQ-DI are clinically relevant.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005899","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:30:18Z","timestamp":1758519018000},"page":"e005899","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of the minimal clinically important difference for the Health Assessment Questionnaire Disability Index in patients with arthralgia at risk for progression to rheumatoid arthritis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6299-7653","authenticated-orcid":false,"given":"Stijn","family":"Claassen","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3251-0238","authenticated-orcid":false,"given":"Hanna W","family":"van Steenbergen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8572-1437","authenticated-orcid":false,"given":"Annette H M","family":"van der Helm-van Mil","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"},{"name":"Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"2025092122300890000_11.3.e005899.1","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1093\/rheumatology\/keae044","article-title":"Patient burden and joint inflammation during development of RA from arthralgia: is it similar in ACPA-positive and ACPA-negative disease?","volume":"63","author":"Khidir","year":"2024","journal-title":"Rheumatology (Oxford)"},{"key":"2025092122300890000_11.3.e005899.2","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2016-000419","article-title":"Functional limitations in the phase of clinically suspect arthralgia are as serious as in early clinical arthritis; a longitudinal study","volume":"3","author":"Ten Brinck","year":"2017","journal-title":"RMD Open"},{"key":"2025092122300890000_11.3.e005899.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01193-X"},{"key":"2025092122300890000_11.3.e005899.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02650-8"},{"key":"2025092122300890000_11.3.e005899.5","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(89)90005-6"},{"key":"2025092122300890000_11.3.e005899.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.05.007"},{"key":"2025092122300890000_11.3.e005899.7","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7525-1-20","article-title":"The Stanford Health Assessment Questionnaire: dimensions and practical applications","volume":"1","author":"Bruce","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"2025092122300890000_11.3.e005899.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/03009742.2019.1637932","article-title":"Validation and assessment of minimally clinically important difference of the unadjusted Health Assessment Questionnaire in a Danish cohort: uncovering ordinal bias","volume":"49","author":"\u00d8rnbjerg","year":"2020","journal-title":"Scand J Rheumatol"},{"key":"2025092122300890000_11.3.e005899.9","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.080479"},{"key":"2025092122300890000_11.3.e005899.10","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1080\/14397595.2016.1213490","article-title":"The minimally important difference for the Japanese version of the health assessment questionnaire in patients with rheumatoid arthritis in daily practice","volume":"27","author":"Shidara","year":"2017","journal-title":"Mod Rheumatol"},{"key":"2025092122300890000_11.3.e005899.11","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"2025092122300890000_11.3.e005899.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.012"},{"key":"2025092122300890000_11.3.e005899.13","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003031","article-title":"To treat or not to treat? Current attitudes on treatment aimed at modifying the disease burden in clinically suspect arthralgia: a survey among participants of the TREAT EARLIER trial and healthcare professionals","volume":"9","author":"Krijbolder","year":"2023","journal-title":"RMD Open"},{"key":"2025092122300890000_11.3.e005899.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02649-1"},{"key":"2025092122300890000_11.3.e005899.15","unstructured":"Deane KSC , Feser M , Demoruelle K , et al . Hydroxychloroquine Does Not Prevent the Future Development of Rheumatoid Arthritis in a Population with Baseline High Levels of Antibodies to Citrullinated Protein Antigens and Absence of Inflammatory Arthritis: Interim Analysis of the StopRA Trial [abstract]. 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