ARTHRITIS & RHEUMATISM Vol. 54, No. 10, October 2006, pp 3113–3118 DOI 10.1002/art.22130 © 2006, American College of Rheumatology Changes in Health Assessment Questionnaire Disability Scores Over Five Years in Patients with Rheumatoid Arthritis Compared With the General Population Tuulikki Sokka, 1 Hannu Kautiainen, 2 Pekka Hannonen, 3 and Theodore Pincus 4 Objective. To analyze longitudinal data over 5 years for changes in Health Assessment Questionnaire (HAQ) scores in patients with rheumatoid arthritis (RA) and age- and sex-matched controls from the general population. Methods. In 2000 and 2005, identical self-report questionnaires were mailed to a cohort of patients with RA and control cohort from the community. The ques- tionnaire included the HAQ, which was used to assess functional status. Changes in HAQ scores over 5 years were analyzed. Results. In 2000, 73% of 1,495 patients with RA and 77% of 2,000 general population controls responded to the questionnaire. In 2005, 84% of 2,022 patients with RA and 77% of 1,817 controls responded. A total of 863 patients with RA and 1,176 community controls re- sponded in both 2000 and 2005 and were included in the analyses. Mean baseline HAQ scores were significantly higher in patients with RA than in controls (0.71 versus 0.17; P < 0.001). Over 5 years, the HAQ scores in- creased by 0.01 units per year in both the RA cohort and the community population; in both cohorts, the net change was primarily attributable to individuals over age 70 years. Changes in HAQ scores were similar in patients and controls who had low HAQ scores at baseline. Female patients with baseline HAQ scores of >0.5 had less potential for improvement than did controls. Among subjects in both groups who had HAQ scores >2, death was a common outcome over the next 5 years. Conclusion. Currently, progression of functional disability among patients with RA and among persons in the general population is largely explained by the aging process. Our results showing stable function scores over 5 years in most patients with RA who are younger than age 70 years provide further evidence of improved status of RA patients today compared with the major declines observed in previous decades. Functional status is the most significant prognos- tic measure of long-term outcomes in rheumatoid arthri- tis (RA), such as work disability (1–3), mortality (4–6), costs (7), the need for joint replacement surgery (8), and loss of function (4,9). Furthermore, patients with RA who have significant functional disability have a 3-fold increased risk of mortality compared with that in the general population; this risk is comparable with that in individuals in the general population in the highest quintile for systolic and diastolic blood pressure, choles- terol level, or pack-years of smoking (10). In addition, improvements in disease activity and Health Assessment Questionnaire (HAQ) (11) scores in patients with early RA are associated with favorable long-term outcomes (12), analogous to improved long-term outcomes achieved by normalization of blood pressure or serum cholesterol levels. The HAQ was developed in the late 1970s to measure outcomes in patients with arthritis. Reference values in a normal population were not included in the initial analysis nor in almost all subsequent analyses. Such information would appear to be of considerable interest in view of evidence that poor physical function is a predictor of mortality in nonrheumatic conditions, including congestive heart failure (13) and acquired immunodeficiency syndrome (14,15). In 2004, we re- Supported by a grant from the Central Finland Health Care District. 1 Tuulikki Sokka, MD, PhD: Jyva ¨skyla ¨ Central Hospital, Jy- vaskyla, Finland and Vanderbilt University, Nashville, Tennessee; 2 Hannu Kautiainen, BA: Rheumatism Foundation Hospital, Heinola, Finland; 3 Pekka Hannonen, MD, PhD: Jyva ¨skyla ¨ Central Hospital, Jyvaskyla, Finland; 4 Theodore Pincus, MD: Vanderbilt University, Nashville, Tennessee. Address correspondence and reprint requests to Tuulikki Sokka, MD, Arkisto/Tutkijat, Jyva ¨skyla ¨ Central Hospital, 40620 Jyvas- kyla, Finland. E-mail: tuulikki_sokka@hotmail.com. Submitted for publication April 13, 2006; accepted in revised form June 26, 2006. 3113