title: The impact of joint disease on the Modified Health Assessment Questionnaire scores in rheumatoid arthritis patients: A cross-sectional study using the National Database of Rheumatic Diseases by iR-net in Japan.
abstract: OBJECTIVE
  To investigate the effect of bilateral and unilateral joint disease on the Modified Health Assessment Questionnaire (MHAQ) scores and the differences in joint weighting in rheumatoid arthritis patients.
  
  
  METHODS
  A total of 9212 subjects from the Japanese nationwide cohort database NinJa, 2011, were analyzed. The presence or absence of disease in each joint, including swelling and/or tenderness, was investigated. The correlations between bilateral and unilateral disease in each joint and MHAQ scores were investigated using multivariable logistic regression analysis.
  
  
  RESULTS
  The patients' mean age and disease duration was 63.2 and 12.2 years, respectively. The Disease Activity Score-28 was 3.3. The odds ratios of physical impairment according to the MHAQ using multivariable logistic regression models for bilateral and unilateral joints, respectively, were: shoulder, 4.0 and 1.8; elbow, 2.6 and 1.8; wrist, 1.9 and 1.5; hip, 1.7 and 3.0; knee, 2.6 and 1.9; ankle, 2.3 and 2.0, finger, 1.4 and 1.2; and toe, 1.0 and 1.1. The shoulder, elbow, wrist, knee, and ankle had a significant effect on physical impairment.
  
  
  CONCLUSIONS
  The MHAQ score was significantly affected by shoulder, elbow, wrist, knee, and ankle joint disease. Furthermore, bilateral disease tended to have a greater effect on physical impairment than unilateral disease.
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Kumiko
authors.initials: K
authors.lastname: Ono
authors.affiliation: b Department of Orthopaedic Surgery , Sagamihara Hospital, National Hospital Organization , Kanagawa , Japan .
authors.forename: Satoru
authors.initials: S
authors.lastname: Ohashi
authors.affiliation: c Department of Medical Research and Management for Musculoskeltal Pain , 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Yuho
authors.initials: Y
authors.lastname: Kadono
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .|d Department of Orthopaedic Surgery , Teikyo University Mizonokuchi Hospital , Kanagawa , Japan , and.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yasui
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Omata
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Jinju
authors.initials: J
authors.lastname: Nishino
authors.affiliation: a Department of Orthopaedic Surgery , Faculty of Medicine, University of Tokyo , Tokyo , Japan .
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: e Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization , Kanagawa , Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D007596:Joints / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Cohort study; Joint involvement; Physical function; Rheumatoid arthritis; Scoring system