{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:24:21Z","timestamp":1777983861561,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Nationale vereniging voor mensen met lupus, APS, sclerodermie en MCTD"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The Health Assessment Questionnaire\u2013Disability Index is an important outcome measure reflecting functional disability, but knowledge on its course over time in patients with systemic sclerosis is scarce. Therefore, we investigated the long-term course of the Health Assessment Questionnaire\u2013Disability Index and its association with baseline characteristics in systemic sclerosis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Systemic sclerosis patients, fulfilling the European League Against Rheumatism and the American College of Rheumatology 2013 criteria, were included from the Leiden Combined Care in Systemic Sclerosis cohort with annual assessments including the Scleroderma Health Assessment Questionnaire\u2013Disability Index (range\u2009=\u20090\u20133). The course of the Health Assessment Questionnaire\u2013Disability Index was evaluated over the total follow-up (baseline to last available Health Assessment Questionnaire\u2013Disability Index) and between yearly visits. Based on a minimal clinical important difference of 0.22, courses were categorized into worsening, stable or improvement. The course of the Health Assessment Questionnaire\u2013Disability Index over time was evaluated with linear mixed models. Baseline characteristics were compared between patients with a worsening or improvement of the Health Assessment Questionnaire\u2013Disability Index over the total follow-up period with logistic regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 517 systemic sclerosis patients were included, with a median follow-up of 7\u2009years (interquartile range\u2009=\u20094\u20139; 2649 visits) and a baseline Health Assessment Questionnaire\u2013Disability Index of 0.625 (interquartile range\u2009=\u20090.125\u20131.25). On group level, the Health Assessment Questionnaire\u2013Disability Index is stable with an annual increase of 0.019 (95% confidence interval\u2009=\u20090.011 to 0.027). Looking at subgroups, patients &gt;65\u2009years or who died\/were physically unable to come during follow-up had a worse mean Health Assessment Questionnaire\u2013Disability Index. In individual courses from baseline to the last follow-up, the proportions of patients with a clinically meaningful worsening, stable or improved Health Assessment Questionnaire\u2013Disability Index were 35%, 42% and 23%, respectively. Patients with immunosuppressants (odds ratio\u2009=\u20090.5, 95% confidence interval\u2009=\u20090.3 to 0.9) or gastrointestinal involvement (odds ratio\u2009=\u20090.6, 95% confidence interval\u2009=\u20090.4 to 0.9) at baseline showed a reduced chance of worsening of the Health Assessment Questionnaire\u2013Disability Index over the total follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Over time, the average course of the Health Assessment Questionnaire\u2013Disability Index was stable in systemic sclerosis patients. However, individual courses vary, with worsening occurring in one-third. Worsening occurred less often in individuals using immunosuppressants or with gastrointestinal involvement at baseline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23971983231181719","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T05:42:57Z","timestamp":1687585377000},"page":"192-202","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["The long-term course of the Health Assessment Questionnaire in patients with systemic sclerosis"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0328-7062","authenticated-orcid":false,"given":"Sophie IE","family":"Liem","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sytske Anne","family":"Bergstra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Ciaffi","sequence":"additional","affiliation":[{"name":"Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coen","family":"van der Meulen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A","family":"Ueckert","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisca R","family":"Schriemer","sequence":"additional","affiliation":[{"name":"NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom WJ","family":"Huizinga","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodora PM","family":"Vliet Vlieland","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeska K","family":"de Vries-Bouwstra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,21]]},"reference":[{"key":"bibr1-23971983231181719","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0806188"},{"issue":"6","key":"bibr2-23971983231181719","first-page":"88","volume":"32","author":"Willems LM","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"bibr3-23971983231181719","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq310"},{"key":"bibr4-23971983231181719","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa827"},{"key":"bibr5-23971983231181719","volume":"63","author":"Pope J","year":"2011","journal-title":"Arthritis Care Res"},{"issue":"1","key":"bibr6-23971983231181719","first-page":"167","volume":"30","author":"Bruce B","year":"2003","journal-title":"J 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