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However&#44; patient&#39;s perspective of RA disease worsening or flare represents an experience extending beyond standard clinical outcome measures&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#44;12</span></a> Some authors consider that outcomes of a clinical intervention obtained by the patient i&#46;e&#46;&#44; patient-reported outcomes &#40;PRO&#41; are seemed to be of more importance than any other outcomes like clinical-reported&#46; Several data as impact of disease on condition on daily life can be obtained only from patient&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus&#44; PROs are not only an important aim of treatment but also an important long-term prognostic factor&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a> Beyond this&#44; increased emphasis it is given to the fact that these tools also allow a cost-effectiveness analysis of treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> Thus&#44; we assisted a growing interest by an assessment not only based on objective parameters&#44; but also an assessment that includes the patient&#39;s subjective well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Various generic and specific scales are used for evaluating PROs&#46; These scales not only measure the effectiveness of the treatment as well as assess whether this effectiveness is truly significant in the patient&#39;s perspective&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With disease modifying antirheumatic drugs &#40;DMARDs&#41;&#44; clinical symptoms as well as radiological joint damage are prevented&#46; Achieving clinical remission would ideally be associated with achieving PROs comparable to those in the general population&#46; To date&#44; there have been limited studies about how the changes in the disease activity and classical clinical data relate with changes in the various PROs&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> Furthermore&#44; it is not clear yet whether aiming for remission is worthwhile&#44; especially when compared with low disease activity&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The present study aims &#40;1&#41; to analyze the HRQoL in a sample of patients with RA under biological therapy&#59; &#40;2&#41; to compare HRQoL of patients with RA to that of the portuguese general population&#59; &#40;3&#41; to inquiry about disease activity influence in HRQoL and functional capacity&#59; &#40;4&#41; to determine potential determinants for these outcomes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and patients</span><p id="par0045" class="elsevierStylePara elsevierViewall">We performed a cohort cross-sectional study&#46; The evaluating period was between October 2013 and July 2014 from a university hospital in the north of Portugal&#46; Consecutive RA patients were recruited by participating study physicians during routine clinic visits&#46; We included adult RA patients&#44; diagnosed according to the 2010 ACR&#47;EULAR classification criteria&#44; under biological therapy&#46; Patients lacking ability to answer the questionnaires were excluded&#46; Additional exclusion criteria were not applied&#46; A total of 154 patients were included&#46; The medical ethics committee approved the study protocol&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Outcomes measures</span><p id="par0050" class="elsevierStylePara elsevierViewall">HRQoL was captured by the Short Form Health Survey &#40;SF-36&#41; and EQ-5D&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">SF-36 measures physical and mental health on eight subscales &#40;physical functioning &#8211; PF&#44; physical role functioning &#8211; PRF&#44; bodily pain &#8211; BP&#44; general health perceptions &#8211; GHP&#44; vitality &#8211; VT&#44; social role functioning &#8211; SRF&#44; emotional role functioning &#8211; ERF&#44; mental health &#8211; MH&#41;&#44; which are summed up in two scales&#44; the physical and mental summary measures &#40;PSM and MSM&#41;&#46; Each scale comprises four dimensions scored from 0 to 100&#44; with higher scores indicating better HRQoL&#46; We calculated summary scores of the PCS and MCS&#44; as well as single domain scores&#46; These component scores are standardized on the basis of worldwide population norms to a mean of 50 and a standard deviation of 10&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">EQ-5D is applicable to a variety of different illnesses and treatments and provides a simple descriptive profile and a single index value for health status&#46; The five dimensions included in the EQ-5D are&#58; mobility&#59; self-care&#59; usual activities&#59; pain&#47;discomfort and anxiety&#47;depression&#46; Each dimension has three levels &#40;none&#44; some or major problems&#41; and together defines 243 health states &#40;3 to the power of 5 gives the 243 possible combination&#41;&#44; to which has been added &#8220;unconscious&#8221; and &#8220;dead&#8221; for a total of 245 health states&#46; EQ-5D scores range between &#8722;0&#46;594 and 1 &#40;full health&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Limitations in activities of daily life were assessed by portuguese version of the Health Assessment Questionnaire &#40;HAQ&#41; which comprises eight categories&#46; A score of 0 &#40;no difficulty&#41;&#44; 1 &#40;some difficulty&#41;&#44; 2 &#40;much difficulty or need of assistance&#41; or 3 &#40;unable to perform&#41; is given to each question&#59; the highest score in each category represents the score for that category&#46; The sum of scores is then divided by the number of categories&#44; yielding a total score ranging from 0 &#40;best&#41; to 3 &#40;worst&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Visual Analog Scales &#40;VASs&#41; were used&#44; on which patients had to indicate on a scale from 0 &#40;none&#41; to 100 &#40;worst&#41; mm their rating of disease activity &#40;VAS-DA&#41; and pain &#40;VAS-P&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0075" class="elsevierStylePara elsevierViewall">Data collection was performed in the rheumatology day-care hospital unit and through the longitudinal national database &#8220;reuma&#46;pt&#8221;&#46; The collected variables were C-reactive protein &#40;CRP&#41;&#44; erythrocyte sedimentation rate &#40;ESR&#41;&#44; numbers of swollen and tender joints by using a 28-joint count &#40;SJC28&#44; TJC28&#41;&#59; VAS-P and VAS-DA&#44; and HAQ&#46; Composite indices&#44; such as the simplified disease activity indice &#40;SDAI&#41; and the Disease Activity Score using 28-joint counts &#40;DAS28-4V&#41; were calculated by informatic system&#46; Age&#44; gender&#44; level of education&#44; marital and employment status as well as additional disease characteristics &#8211; disease duration&#44; rheumatoid factor &#40;RF&#41; and anti-cyclic citrullinated peptide antibody &#40;anti-ACCP&#41; status&#44; extra-articular manifestations &#40;rheumatoid nodules&#44; ocular&#44; rheumatoid vasculites and pleuropulmonary&#41; and DMARDs use &#8211; were also recorded&#46; The application of questionnaires&#44; available in the computer system&#44; was held through face-to-face interviews&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analyses</span><p id="par0080" class="elsevierStylePara elsevierViewall">In the description of socio-demographic and clinical characteristics as well as in the description of PROs &#40;eight domains of SF-36&#44; PSM&#44; MSM&#44; EQ-5D&#44; HAQ&#44; VAS&#41; were used means and standard deviations for continuous variables with symmetrical distribution and median and range &#40;minimum and maximum&#41; for the variables continuous with asymmetric distribution&#46; Categorical variables were expressed as proportions&#46; To compare HRQoL of our RA patients to that of the portuguese general population&#44; we used SF-36 published data by Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> Measures of central tendency were compared using the Mann&#8211;Whitney test&#46; To investigate whether outcomes are different at different levels of disease activity we divided sample according to level of disease activity by SDAI&#58; remission &#40;REM&#41; SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#44; low disease activity &#40;LDA&#41; 3&#46;3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11&#44; moderate disease activity &#40;MDA&#41; 11<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>26 and high disease activity &#40;HDA&#41; SDAI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>26&#46; The comparison of outcomes was performed using Kruskal Wallis test and Fisher&#39;s exact test&#44; for medians and categorical variables&#44; respectively&#46; To assess the relationship between clinical data and the PROs&#44; Spearman correlations &#40;<span class="elsevierStyleItalic">&#961;</span>&#41; were performed&#46; To identify explanatory variables of HRQoL and functional capacity we conducted a multiple linear regression &#40;stepwise selection&#41; and included variables statistically significant in univariate analysis and those considered clinically relevant&#46; We assessed correlations between the continuous variables and HRQoL with Spearman correlation to check for collinearity&#46; Linear regression model assumptions were examined and satisfied&#46; Residual plots were examined for goodness of fit&#46; Analyses were performed using the program SPSS Version 21&#46; The <span class="elsevierStyleItalic">p</span>-values below 0&#46;05 were considered significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Socio-demographic&#44; clinical and laboratory characteristics are documented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; At the moment of this study we found that 8&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41; were in REM&#44; 53&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41; had LDA&#44; 33&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; had MDA and 4&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; had HDA&#46; Most patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41; were under the first biological agent and the median time under the drug was 6 years &#40;range 0&#8211;10&#41;&#46; Eight patients &#40;5&#46;2&#37;&#41; were under the current drug for 10 years and 27 &#40;17&#46;5&#37;&#41; for 2 years or less&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">HRQoL and functional status of RA patients</span><p id="par0090" class="elsevierStylePara elsevierViewall">After analysing all domains of the SF-36 we observed that the domain with lowest score was the &#8220;Physical Performance&#8221; &#40;median 25&#41; followed by the domain &#8220;General Health&#8221; and &#8220;Physical Functioning&#8221; &#40;median 40 for both&#41;&#46; Mental domains showed higher values&#59; among them&#44; domain &#8220;Social Functioning&#8221; showed the lowest score &#40;median 40&#59; range 3&#8211;53&#41;&#46; The domain &#8220;Role-Emotional&#8221; had a median of 100 &#40;range 0&#8211;100&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Likewise&#44; we found that in SF-36 summary measure&#44; PSM was lower than MSM &#40;median 32 vs&#46; 52&#41;&#46; With the application of EQ-5D also observed a low score &#40;median 0&#46;620&#44; range &#8722;0&#46;349 to 1&#46;000&#41;&#46; In our sample&#44; 5&#37; of patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; had scores on the EQ-5D less than zero &#40;states worse than dead&#41;&#46; Median score was 1&#46;250 &#40;range 0&#46;000&#8211;2&#46;875&#41; for HAQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When comparing primary outcomes between genders we found significant statistical differences only for the HAQ in which woman presented worse results &#40;median 1&#46;38 vs&#46; 0&#46;88&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#46; There were no significant differences in PROs when evaluated according to disease duration &#40;&#8804;10 or &#62;10 years&#41;&#44; RF and ACCP status&#44; presence of extra-articular manifestations or current biological therapy&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Comparison of HRQoL of RA patients with general Portuguese population</span><p id="par0105" class="elsevierStylePara elsevierViewall">HRQoL of our RA patients is lower than the general Portuguese population&#46; Our patients had significantly lower scores in all domains of the SF-36&#44; except for &#8220;Emotional role functioning&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Regarding summary measures there is a significant difference in MSF &#40;median 32 vs&#46; 50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; but not in the MSM &#40;median 50 vs&#46; 52&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;503&#41;&#46; The same was observed through EQ-5D in which our patients had lower median score than general Portuguese population &#40;0&#46;620 vs&#46; 0&#46;758&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Comparing the HRQoL of general Portuguese population with our patients in clinical remission&#44; we found similars scores for the several individual domains and the summary measures of SF-36 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding EQ-5D values&#44; we also found identical values between REM group and the general population &#40;0&#46;848 vs&#46; 0&#46;758&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">HRQoL and functional disability correlate significantly with disease-activity levels</span><p id="par0115" class="elsevierStylePara elsevierViewall">The performed analysis by disease activity groups showed significant differences in all applied instruments &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When we access the functional capacity using the domains of physical health of the SF-36 &#40;PF&#44; PRF&#44; BP and GHP&#41; we also found statistically significant difference&#44; showing worst scores with highest disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyzes&#41;&#46; For the SF-36 mental health domains we only observed progressive decrease in the score with increase of level of activity disease on the &#8220;mental health&#8221; domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The same was true for the SF-36 summary measures&#44; i&#46;e&#46;&#44; decreasing scores of PSM with increasing levels of disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and overlapping MSM values &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; When we assessed potential differences in HRQoL by other measures&#44; such as EQ-5D&#44; we found very similar results &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Comparing functional disability by HAQ at the four levels of disease activity&#44; we observed significant differences between groups&#44; showing a HAQ increase with increasing disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In order to compare the benefit of remission with state of low disease activity with respect to the PRO we directly compared REM group with LDA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In this analysis we observed a statistically significant difference in all PRO &#40;SF-36&#44; EQ-5D&#44; HAQ and VAS&#41; except in &#8220;Vitality&#8221; and &#8220;Social role functioning&#8221; domains and mental summary measure of the SF-36&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">HRQoL and functional disability have a weak correlation with clinical and laboratory data</span><p id="par0135" class="elsevierStylePara elsevierViewall">We evaluated the relationship between the various clinical and laboratory parameters with the PRO through the Spearman correlation &#40;<span class="elsevierStyleItalic">&#961;</span>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The analyzed clinical and laboratory variables were&#58; current age and age at disease onset&#44; disease duration&#44; education level&#44; CRP&#44; ESR&#44; tender and swollen 28-joint count&#44; DAS28 change&#44; VAS-P and VAS-GH&#46; We also studied the relationship between the PSM of SF-36 and initial and actual HAQ&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">For PSM we concluded that variables with strongest relationship were those that correspond to other PRO&#44; namely current and initial HAQ &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;67 and &#8722;0&#46;48&#44; respectively&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;62&#41; and VAS-GH &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;58&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyses&#41;&#46; The relationship with tender and swollen 28-joint count&#44; although significant&#44; was much lower &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;35 and &#8722;0&#46;20&#44; respectively&#41;&#46; There was no correlation with ESR &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;84&#41; nor with CRP &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;365&#41;&#46; For MSM no significant correlations were identified&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The HAQ also showed weak correlation with ESR&#44; CRP and 28-joint count&#46; The strongest correlations were observed with PSM of SF-36 &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;674&#41;&#44; VAS-GH &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;609&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;601&#41; and initial HAQ &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;595&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyzes&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Again&#44; we verified that variables with strongest correlation with EQ-5D were other PRO &#40;VAS-GH <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;573 and VAS-P <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;560&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41; and not the clinical or laboratory classics data&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">There was not a significant association between the SF-36&#44; EQ-5D and HAQ with the variation of DAS28-4V&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Determinants of HRQoL</span><p id="par0165" class="elsevierStylePara elsevierViewall">The potential explanatory variables considered for summary measures of the SF-36&#44; EQ-5D and HAQ were age&#44; gender&#44; level of education&#44; employment status&#44; disease duration&#44; VAS-GH&#44; VAS-P&#44; tender and swollen 28-joint count&#44; ESR&#44; CRP and DAS28-4V change&#46; For SF-36 and EQ-5D we also included HAQ questionnaire&#46; The regression coefficients are documented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; HAQ&#44; VAS-P and level of education were retained as explanatory variables for PSM&#46; The explained variance &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; was 55&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and HAQ had the stronger effect on PSM &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;9&#46;119&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; For MSM&#44; the model has not retained any significant explanatory variable&#46; Therefore&#44; we found no demographic or clinical variable to explain mental health&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">HAQ and VAS-GH were retained as explanatory variables for EQ-5D and the model&#39;s explanation of the variance was significant &#40;46&#46;4&#37;&#41;&#46; As observed for PSM&#44; HAQ was the variable with stronger effect on the EQ-5D &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;208&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Studying HAQ determinants&#44; we found that higher age&#44; female gender&#44; current employment&#44; VAS-P and VAS-GH explained 50&#37; of the variation&#46; Presence of current employment was the variable with the greatest impact on functional capacity &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;313&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Clinical and laboratory classic data &#40;joint count&#44; acute-phase reactants and DAS28-4V change&#41; showed no explanatory effect on HRQoL and functional capacity of these patients&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">The present study provides information on the effect of RA on HRQoL and functional capacity&#44; in a real world setting&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Our results corroborate previous studies showing that patients with RA had not only significant physical function and mental health impairment but also poor HRQoL when compared to general Portuguese population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> Differences are particularly notable on physical domains of SF-36 however&#44; RA patients also present levels of mental health subscales significantly lower than general population&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study we verified values of EQ-5D corresponding to states of &#8220;full health&#8221;&#46; Several factors may explain this finding&#46; One of the disadvantages of the EQ5D is that may suffer from ceiling effect&#46; The questionnaire is not sensitive enough to discriminate between different levels of health because the dimensions are probably not sufficiently disaggregated&#44; leading individuals to respond at the highest level&#46; These finding may indicate that individuals with significant morbidity are misclassified as in full health on the EQ-5D descriptive system&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">When we evaluated disease activity influence in HRQoL and functional capacity&#44; we found significant negative correlation &#40;HRQoL and functional impairment with higher disease activity levels&#41;&#46; A interesting finding in our study was to note a stronger correlation between SF-36 and measures of disability and pain &#40;HAQ and VAS-P&#41; than with measures directly related to disease process &#40;ESR&#44; CRP&#44; joint count&#41;&#46; Another finding was the benefit found in these outcomes when REM status was compared directly with LDA&#46; Thus&#44; indicators of quality of life&#44; functional capacity&#44; pain and appreciation of global health patient-reported complementing the clinical evaluation&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">With regard to the potential determinants of these outcomes&#44; we verified that older age and female gender was associated with higher HAQ score&#46; This data confirms previous results&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> Physical function declines with age and it is known that women have lower threshold for pain and that men have more physical strength than women&#46; Current employment was also related to better HAQ scores&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">With regard to HQoL&#44; we identified higher education level and functional capacity as potential determinants&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Unlike other results&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> the duration of disease showed no significant linear relationship with none of the outcomes&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Several limitations of our study should be addressed&#46; We studied a non-representative sample of the Portuguese population&#46; Although the sample was from a reference center of Portugal&#44; this is a convenience sample and the sample size is potentially small&#46; This is a cross-sectional analyses&#59; therefore&#44; prevents to establish directionality of interpretation&#44; i&#46;e&#46;&#44; unknown if group of patients in remission and low disease activity showed better SF-36&#44; EQ-5D and HAQ when presented higher levels of disease activity&#46; Other limitation is the fact that the joint damage was not assessed&#46; This becomes relevant for two reasons&#46; We observed that most patients studied have disease for over 10 years and we know that in late disease the functional capacity is most associated with joint damage&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> The other reason is when we compare our sample with general population and observed that although all domains that compose the PSM were significantly lower&#44; the difference is more pronounced for &#8220;physical functioning&#8221; and &#8220;physical role functioning&#8221; domains than for the &#8220;bodily pain&#8221; domain&#46; Many patients with inactive disease but with important damage have functional limitations but do not refer pain complaints&#46; Finally&#44; the Portuguese population used to compare the HRQoL presents some characteristics that may affect the validity of the results&#46; About 40&#37; of the people interviewed report some type of pathology &#40;namely musculoskeletal&#41;&#46; However&#44; this data has not been clinically confirmed based solely on patient-reported&#46; Data such as gender and age were similar&#46; Most were female and were between 30 and 69 years of age&#46; In this way&#44; we believe that there was no great influence on the results&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Strengths of the present analyses were the inclusion of a sample of patients with a broad range of clinical characteristics&#44; rather than the more homogeneous populations of the trials&#59; the focus on the more-stringent SDAI remission criteria&#44; which allowed the recognition of the differences between REM and all other states&#44; including LDA&#59; it addressed quality of life not only through the state of health &#40;SF-36&#41; but also by assessing the value of health &#40;EQ-5D&#41; reported by the patient&#46; The fact that it included the utility measure will enable future cost-effectiveness studies&#46; Finally&#44; analysis of summary measures of SF-36 as well as each of the domains provides a clearer picture of the dimensions affected by the disease&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">We consider our results useful to better understand the impact of disease and establish a basis for future prospective studies with larger samples to assess the efficacy of therapeutic interventions&#46; The focus on seriously ill patients in need of costly therapy may also be useful for cost-utility analysis studies of biotech drugs&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0235" class="elsevierStylePara elsevierViewall">RA has considerable impact on quality of life and functional capacity being the impairment of HRQoL enormous when compared to general population&#46; We verified lower HRQoL and functional capacity with higher disease activity levels and we saw that reaching remission seems to be a desirable state also from patient perspective&#46; Since the clinical and laboratory data are weakly correlated with HRQoL and functional capacity&#44; we believe that access to PROs is very important in order to complete the disease assessment&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical disclosures</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of human and animal subjects</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Confidentiality of data</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0255" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Authors contributions</span><p id="par0260" class="elsevierStylePara elsevierViewall">All authors make substantial contributions to conception and design&#44; acquisition of data&#44; or analysis and interpretation of data&#46; All critically revise it for important critical content and give final approval of the version of the article accepted for publication&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">None of the authors has any conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the Health related Quality of Life &#40;HRQoL&#41; and physical function in rheumatoid arthritis &#40;RA&#41; patients and compare it with the general population&#46; We also intended to analyze about disease activity influence in HRQoL and functional capacity&#44; as well as determine potential determinants for these outcomes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was conducted in RA patients from a university hospital of Portugal&#46; We obtained Short Form 36&#44; EuroQoL 5D&#44; health assessment questionnaire&#44; visual analog scale for pain and patient&#39;s assessment of disease activity&#46; Comparisons between SF-36 and EQ-5D values with our population reference values were conducted using the Mann&#8211;Whitney test&#46; Data were compared in different levels of disease activity&#44; using Kruskal Wallis test and Fisher&#39;s exact test&#46; A multiple regression analysis was conducted to identify the potential determinants of outcomes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">RA sample showed significantly lower values than the portuguese general population on physical summary measure of SF-36 &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 vs&#46; 50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and EQ-5D &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;620 vs&#46; 0&#46;758 respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Lower disease activity levels had better PROs and this was true even when compared patients achieving remission with those in low disease activity&#46; The HAQ &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#37;&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#37;&#41; and VAS-DA &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#37;&#41; were the variables that strongly related to SF-36&#46; Considering HAQ&#44; the strongest relation was found with VAS-P&#44; VAS-DA and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#37;&#44; 61&#37; and 33&#37;&#44; respectively&#41;&#46; Multiple regression analysis identified HAQ&#44; VAS-P and educational status as determinants of the HRQoL&#59; age&#44; female gender&#44; employment&#44; VAS-P and VAS-DA as determinants of physical function&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Impairment of HRQoL in RA patients is enormous&#46; We found significant differences between different levels of disease activity&#44; showing higher HRQoL and functional capacity at lower disease activity levels&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la evaluaci&#243;n del Health related Quality of Life &#40;HRQoL&#41; y la funci&#243;n f&#237;sica en pacientes con artritis reumatoide &#40;AR&#41; y compararla con la poblaci&#243;n general&#46; Tambi&#233;n se pretende analizar la influencia de la actividad de la enfermedad en el HRQoL y la capacidad funcional&#44; as&#237; como definir los determinantes potenciales de estos resultados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio transversal en pacientes con AR de un hospital universitario de Portugal&#46; Se obtuvieron los cuestionarios Short Form 36&#44; EuroQol 5D&#44; Health Assessment Questionnaire&#44; la escala anal&#243;gica visual de dolor y la evaluaci&#243;n de la actividad de la enfermedad&#46; Las comparaciones entre los valores de SF-36 y EQ-5D con los valores de referencia de nuestra poblaci&#243;n se conducier&#243;n utilizando el test de Mann-Whitney&#46; Los datos se compararon en diferentes niveles de actividad de la enfermedad utilizando el test de Kruskal Wallis y la prueba exacta de Fisher&#46; Se realiz&#243; un an&#225;lisis de regresi&#243;n m&#250;ltiple para identificar los determinantes potenciales de los resultados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La muestra de AR mostr&#243; valores significativamente m&#225;s bajos que la poblaci&#243;n general portuguesa en la medici&#243;n f&#237;sica de SF-36 &#40;mediana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 vs&#46; 50&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y EQ-5D &#40;mediana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;620 vs&#46; 0&#44;758&#44; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los pacientes con niveles de actividad de la enfermedad m&#225;s bajos tuvieron mejores PRO y esto fue cierto incluso cuando se compararon los pacientes que alcanzaron la remisi&#243;n con aquellos en baja actividad de la enfermedad&#46; El HAQ &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#37;&#41;&#44; VAS-P &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#37;&#41; y VAS-DA &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#37;&#41; fueron las variables fuertemente relacionadas con SF-36&#46; Con respecto a el HAQ&#44; se encontr&#243; una relaci&#243;n m&#225;s fuerte con VAS-P&#44; VAS-DA y la edad &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#37;&#44; el 61 y el 33&#37;&#44; respectivamente&#41;&#46; El an&#225;lisis de regresi&#243;n m&#250;ltiple identific&#243; el HAQ&#44; el VAS-P y el nivel de estudios como determinantes del HRQoL y la edad&#44; el g&#233;nero femenino&#44; el empleo&#44; VAS-P y VAS-DA como determinantes de la funci&#243;n f&#237;sica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El deterioro del HRQoL en los pacientes con AR es enorme&#46; Se encontraron diferencias significativas entre los diferentes niveles de actividad de la enfermedad&#44; mostrando mayor HRQoL y capacidad funcional en niveles m&#225;s bajos de actividad de la enfermedad&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of SF-36 values of RA patients with general Portuguese population&#46; Significant differences of different domains of SF-36 was found &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyses&#44; except emotional role functioning &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;079&#41;&#44; <span class="elsevierStyleItalic">p</span>-value using Mann&#8211;Whitney test&#46;</p>"
        ]
      ]
      1 => array:7 [
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of SF-36 in patients with remission state with general Portuguese population&#46;</p>"
        ]
      ]
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of SF-36 among levels of disease activity determined by SDAI &#40;remission &#40;REM SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#59; low disease activity &#40;LDA&#41; 3&#46;3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11&#59; moderate disease activity &#40;MDA&#41; 11<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>26 and high disease activity &#40;HDA&#41; SDAI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>26&#41;&#41;&#46; Significant differences of different domains of SF-36 was found &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyses by Kruskal Wallis test&#41;&#46;</p>"
        ]
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">EAM&#44; extra-articular manifestations&#59; RF&#44; rheumatoid factor&#59; ACCP&#44; anti-cyclic citrullinated peptide antibody&#59; cDMARDs&#44; classic disease-modifying anti-rheumatic drugs&#59; bDMARDs&#44; biological disease-modifying anti-rheumatic drugs&#59; SJC28&#44; swollen joints by using a 28-joint count&#59; TJC28&#44; tender joints by using a 28-joint count&#59; CRP&#44; <span class="elsevierStyleItalic">C-reactive protein</span>&#59; ESR&#44; erythrocyte sedimentation rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>154&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Smoking</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ex-smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Education</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;4th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8211;9th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#8211;12th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;12th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Work</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Current&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retired &#40;due to disability&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Disease duration &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;2&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">With EAM &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antibodies &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RF and&#47;or ACCP &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RF and ACCP &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Previous cDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Previous bDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Current cDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">TJC 28</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SJC 28</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CRP &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28 &#40;0&#46;01&#8211;5&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ESR &#40;mm&#47;1&#170;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;1&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">VAS-P&#44; visual analog scales of pain&#59; VAS-GH&#44; visual analog scale for general health&#59; HAQ&#44; Health Assessment Questionnaire&#59; EQ-5D&#44; EuroQol five dimensions questionnaire&#59; SF-36&#44; Short Form Health Survey&#59; PH&#44; physical health&#59; PRF&#44; physical role functioning&#59; BP&#44; bodily pain&#59; GHP&#44; general health perceptions&#59; VT&#44; vitality&#44; SRF&#44; social role functioning&#59; ERF&#44; emotional role functioning&#59; MH&#44; mental health&#59; PSM&#44; physical summary measures&#59; MSM&#44; mental summary measures&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Values presented as medians &#40;range&#41;&#46; P-value between different groups of disease activity by &#42;Mann-Whitney and &#42;&#42; Kruskal-Wallis test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">REM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value between REM and LDA&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VAS-P</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;0&#8211;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;5 &#40;0&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;50&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VAS-GH</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;20&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;50&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HAQ</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;25 &#40;0&#46;00&#8211;2&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50 &#40;0&#46;00&#8211;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13 &#40;0&#46;00&#8211;2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;63 &#40;0&#46;38&#8211;2&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;00 &#40;1&#46;13&#8211;2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">EQ-5D</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;620 &#40;&#8722;0&#46;349&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;848 &#40;0&#46;708&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;673 &#40;&#8722;0&#46;349&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;516 &#40;&#8722;0&#46;349&#8211;0&#46;812&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;516 &#40;0&#46;053&#8211;0&#46;760&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">SF-36&#58; PH</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;45&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;5&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;5&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;10&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;10&#8211;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GHP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;35&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;10&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;15&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">SF-36&#58; MH</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;20&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;40&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;20&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;30&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;45&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;3&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;28&#8211;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;13&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;3&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#40;15&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ERF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;28&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;4&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;32&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;14&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;18&#8211;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;15&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;14&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;14&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;23&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;33&#8211;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;23&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;36&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;43&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;839&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher VAS-P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;165<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8211;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;014&#8211;0&#46;480&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;313<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;484 to &#8722;0&#46;141&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                            2 => "J&#46; Morel"
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Original Article
Quality of life and functional capacity in patients with rheumatoid arthritis – Cross-sectional study
Calidad de vida y capacidad funcional en pacientes con artritis reumatoide – Estudio transversal
Diana Rosa-Gonçalves
Autor para correspondencia
di9_goncalves@hotmail.com

Corresponding author.
, Miguel Bernardes, Lúcia Costa
Rheumatology Department of Centro Hospitalar São João (CHSJ), Oporto, Portugal
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and economic burden to patients and society&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently&#44; there are many treatment options although none of them completely treat RA&#46; Thus&#44; the aim of treatment is not only to achieve remission but minimize the disease consequences on patients by increasing the HRQoL and physical function&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">5&#8211;7</span></a> HRQL is an additional metric to assess patients&#8217; subjective perspective on their experience of pain and its adverse impact on their lives&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">With the advent of the biologic therapy&#44; a growing attention was dedicated by physicians to the precise evaluation of outcomes of therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> Disease activity is the strongest predictor of disability and that clinical and laboratory markers are important in their assessment and treatment response&#46; However&#44; patient&#39;s perspective of RA disease worsening or flare represents an experience extending beyond standard clinical outcome measures&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#44;12</span></a> Some authors consider that outcomes of a clinical intervention obtained by the patient i&#46;e&#46;&#44; patient-reported outcomes &#40;PRO&#41; are seemed to be of more importance than any other outcomes like clinical-reported&#46; Several data as impact of disease on condition on daily life can be obtained only from patient&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus&#44; PROs are not only an important aim of treatment but also an important long-term prognostic factor&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a> Beyond this&#44; increased emphasis it is given to the fact that these tools also allow a cost-effectiveness analysis of treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> Thus&#44; we assisted a growing interest by an assessment not only based on objective parameters&#44; but also an assessment that includes the patient&#39;s subjective well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Various generic and specific scales are used for evaluating PROs&#46; These scales not only measure the effectiveness of the treatment as well as assess whether this effectiveness is truly significant in the patient&#39;s perspective&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With disease modifying antirheumatic drugs &#40;DMARDs&#41;&#44; clinical symptoms as well as radiological joint damage are prevented&#46; Achieving clinical remission would ideally be associated with achieving PROs comparable to those in the general population&#46; To date&#44; there have been limited studies about how the changes in the disease activity and classical clinical data relate with changes in the various PROs&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> Furthermore&#44; 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Consecutive RA patients were recruited by participating study physicians during routine clinic visits&#46; We included adult RA patients&#44; diagnosed according to the 2010 ACR&#47;EULAR classification criteria&#44; under biological therapy&#46; Patients lacking ability to answer the questionnaires were excluded&#46; Additional exclusion criteria were not applied&#46; A total of 154 patients were included&#46; The medical ethics committee approved the study protocol&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Outcomes measures</span><p id="par0050" class="elsevierStylePara elsevierViewall">HRQoL was captured by the Short Form Health Survey &#40;SF-36&#41; and EQ-5D&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">SF-36 measures physical and mental health on eight subscales &#40;physical functioning &#8211; PF&#44; physical role functioning &#8211; PRF&#44; bodily pain &#8211; BP&#44; 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The sum of scores is then divided by the number of categories&#44; yielding a total score ranging from 0 &#40;best&#41; to 3 &#40;worst&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Visual Analog Scales &#40;VASs&#41; were used&#44; on which patients had to indicate on a scale from 0 &#40;none&#41; to 100 &#40;worst&#41; mm their rating of disease activity &#40;VAS-DA&#41; and pain &#40;VAS-P&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0075" class="elsevierStylePara elsevierViewall">Data collection was performed in the rheumatology day-care hospital unit and through the longitudinal national database &#8220;reuma&#46;pt&#8221;&#46; The collected variables were C-reactive protein &#40;CRP&#41;&#44; erythrocyte sedimentation rate &#40;ESR&#41;&#44; numbers of swollen and tender joints by using a 28-joint count &#40;SJC28&#44; TJC28&#41;&#59; VAS-P and VAS-DA&#44; and HAQ&#46; Composite indices&#44; such as the simplified disease activity indice &#40;SDAI&#41; and the Disease Activity Score using 28-joint counts &#40;DAS28-4V&#41; were calculated by informatic system&#46; Age&#44; gender&#44; level of education&#44; marital and employment status as well as additional disease characteristics &#8211; disease duration&#44; rheumatoid factor &#40;RF&#41; and anti-cyclic citrullinated peptide antibody &#40;anti-ACCP&#41; status&#44; extra-articular manifestations &#40;rheumatoid nodules&#44; ocular&#44; rheumatoid vasculites and pleuropulmonary&#41; and DMARDs use &#8211; were also recorded&#46; The application of questionnaires&#44; available in the computer system&#44; was held through face-to-face interviews&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analyses</span><p id="par0080" class="elsevierStylePara elsevierViewall">In the description of socio-demographic and clinical characteristics as well as in the description of PROs &#40;eight domains of SF-36&#44; PSM&#44; MSM&#44; EQ-5D&#44; HAQ&#44; VAS&#41; were used means and standard deviations for continuous variables with symmetrical distribution and median and range &#40;minimum and maximum&#41; for the variables continuous with asymmetric distribution&#46; Categorical variables were expressed as proportions&#46; To compare HRQoL of our RA patients to that of the portuguese general population&#44; we used SF-36 published data by Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> Measures of central tendency were compared using the Mann&#8211;Whitney test&#46; To investigate whether outcomes are different at different levels of disease activity we divided sample according to level of disease activity by SDAI&#58; remission &#40;REM&#41; SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#44; low disease activity &#40;LDA&#41; 3&#46;3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11&#44; moderate disease activity &#40;MDA&#41; 11<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>26 and high disease activity &#40;HDA&#41; SDAI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>26&#46; The comparison of outcomes was performed using Kruskal Wallis test and Fisher&#39;s exact test&#44; for medians and categorical variables&#44; respectively&#46; To assess the relationship between clinical data and the PROs&#44; Spearman correlations &#40;<span class="elsevierStyleItalic">&#961;</span>&#41; were performed&#46; To identify explanatory variables of HRQoL and functional capacity we conducted a multiple linear regression &#40;stepwise selection&#41; and included variables statistically significant in univariate analysis and those considered clinically relevant&#46; We assessed correlations between the continuous variables and HRQoL with Spearman correlation to check for collinearity&#46; Linear regression model assumptions were examined and satisfied&#46; Residual plots were examined for goodness of fit&#46; Analyses were performed using the program SPSS Version 21&#46; The <span class="elsevierStyleItalic">p</span>-values below 0&#46;05 were considered significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Socio-demographic&#44; clinical and laboratory characteristics are documented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; At the moment of this study we found that 8&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41; were in REM&#44; 53&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41; had LDA&#44; 33&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; had MDA and 4&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; had HDA&#46; Most patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41; were under the first biological agent and the median time under the drug was 6 years &#40;range 0&#8211;10&#41;&#46; Eight patients &#40;5&#46;2&#37;&#41; were under the current drug for 10 years and 27 &#40;17&#46;5&#37;&#41; for 2 years or less&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">HRQoL and functional status of RA patients</span><p id="par0090" class="elsevierStylePara elsevierViewall">After analysing all domains of the SF-36 we observed that the domain with lowest score was the &#8220;Physical Performance&#8221; &#40;median 25&#41; followed by the domain &#8220;General Health&#8221; and &#8220;Physical Functioning&#8221; &#40;median 40 for both&#41;&#46; Mental domains showed higher values&#59; among them&#44; domain &#8220;Social Functioning&#8221; showed the lowest score &#40;median 40&#59; range 3&#8211;53&#41;&#46; The domain &#8220;Role-Emotional&#8221; had a median of 100 &#40;range 0&#8211;100&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Likewise&#44; we found that in SF-36 summary measure&#44; PSM was lower than MSM &#40;median 32 vs&#46; 52&#41;&#46; With the application of EQ-5D also observed a low score &#40;median 0&#46;620&#44; range &#8722;0&#46;349 to 1&#46;000&#41;&#46; In our sample&#44; 5&#37; of patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; had scores on the EQ-5D less than zero &#40;states worse than dead&#41;&#46; Median score was 1&#46;250 &#40;range 0&#46;000&#8211;2&#46;875&#41; for HAQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When comparing primary outcomes between genders we found significant statistical differences only for the HAQ in which woman presented worse results &#40;median 1&#46;38 vs&#46; 0&#46;88&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#46; There were no significant differences in PROs when evaluated according to disease duration &#40;&#8804;10 or &#62;10 years&#41;&#44; RF and ACCP status&#44; presence of extra-articular manifestations or current biological therapy&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Comparison of HRQoL of RA patients with general Portuguese population</span><p id="par0105" class="elsevierStylePara elsevierViewall">HRQoL of our RA patients is lower than the general Portuguese population&#46; Our patients had significantly lower scores in all domains of the SF-36&#44; except for &#8220;Emotional role functioning&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Regarding summary measures there is a significant difference in MSF &#40;median 32 vs&#46; 50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; but not in the MSM &#40;median 50 vs&#46; 52&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;503&#41;&#46; The same was observed through EQ-5D in which our patients had lower median score than general Portuguese population &#40;0&#46;620 vs&#46; 0&#46;758&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Comparing the HRQoL of general Portuguese population with our patients in clinical remission&#44; we found similars scores for the several individual domains and the summary measures of SF-36 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding EQ-5D values&#44; we also found identical values between REM group and the general population &#40;0&#46;848 vs&#46; 0&#46;758&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">HRQoL and functional disability correlate significantly with disease-activity levels</span><p id="par0115" class="elsevierStylePara elsevierViewall">The performed analysis by disease activity groups showed significant differences in all applied instruments &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When we access the functional capacity using the domains of physical health of the SF-36 &#40;PF&#44; PRF&#44; BP and GHP&#41; we also found statistically significant difference&#44; showing worst scores with highest disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyzes&#41;&#46; For the SF-36 mental health domains we only observed progressive decrease in the score with increase of level of activity disease on the &#8220;mental health&#8221; domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The same was true for the SF-36 summary measures&#44; i&#46;e&#46;&#44; decreasing scores of PSM with increasing levels of disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and overlapping MSM values &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; When we assessed potential differences in HRQoL by other measures&#44; such as EQ-5D&#44; we found very similar results &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Comparing functional disability by HAQ at the four levels of disease activity&#44; we observed significant differences between groups&#44; showing a HAQ increase with increasing disease activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In order to compare the benefit of remission with state of low disease activity with respect to the PRO we directly compared REM group with LDA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In this analysis we observed a statistically significant difference in all PRO &#40;SF-36&#44; EQ-5D&#44; HAQ and VAS&#41; except in &#8220;Vitality&#8221; and &#8220;Social role functioning&#8221; domains and mental summary measure of the SF-36&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">HRQoL and functional disability have a weak correlation with clinical and laboratory data</span><p id="par0135" class="elsevierStylePara elsevierViewall">We evaluated the relationship between the various clinical and laboratory parameters with the PRO through the Spearman correlation &#40;<span class="elsevierStyleItalic">&#961;</span>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The analyzed clinical and laboratory variables were&#58; current age and age at disease onset&#44; disease duration&#44; education level&#44; CRP&#44; ESR&#44; tender and swollen 28-joint count&#44; DAS28 change&#44; VAS-P and VAS-GH&#46; We also studied the relationship between the PSM of SF-36 and initial and actual HAQ&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">For PSM we concluded that variables with strongest relationship were those that correspond to other PRO&#44; namely current and initial HAQ &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;67 and &#8722;0&#46;48&#44; respectively&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;62&#41; and VAS-GH &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;58&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyses&#41;&#46; The relationship with tender and swollen 28-joint count&#44; although significant&#44; was much lower &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;35 and &#8722;0&#46;20&#44; respectively&#41;&#46; There was no correlation with ESR &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;84&#41; nor with CRP &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;365&#41;&#46; For MSM no significant correlations were identified&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The HAQ also showed weak correlation with ESR&#44; CRP and 28-joint count&#46; The strongest correlations were observed with PSM of SF-36 &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;674&#41;&#44; VAS-GH &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;609&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;601&#41; and initial HAQ &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;595&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all analyzes&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Again&#44; we verified that variables with strongest correlation with EQ-5D were other PRO &#40;VAS-GH <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;573 and VAS-P <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;560&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41; and not the clinical or laboratory classics data&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">There was not a significant association between the SF-36&#44; EQ-5D and HAQ with the variation of DAS28-4V&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Determinants of HRQoL</span><p id="par0165" class="elsevierStylePara elsevierViewall">The potential explanatory variables considered for summary measures of the SF-36&#44; EQ-5D and HAQ were age&#44; gender&#44; level of education&#44; employment status&#44; disease duration&#44; VAS-GH&#44; VAS-P&#44; tender and swollen 28-joint count&#44; ESR&#44; CRP and DAS28-4V change&#46; For SF-36 and EQ-5D we also included HAQ questionnaire&#46; The regression coefficients are documented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; HAQ&#44; VAS-P and level of education were retained as explanatory variables for PSM&#46; The explained variance &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; was 55&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and HAQ had the stronger effect on PSM &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;9&#46;119&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; For MSM&#44; the model has not retained any significant explanatory variable&#46; Therefore&#44; we found no demographic or clinical variable to explain mental health&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">HAQ and VAS-GH were retained as explanatory variables for EQ-5D and the model&#39;s explanation of the variance was significant &#40;46&#46;4&#37;&#41;&#46; As observed for PSM&#44; HAQ was the variable with stronger effect on the EQ-5D &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;208&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Studying HAQ determinants&#44; we found that higher age&#44; female gender&#44; current employment&#44; VAS-P and VAS-GH explained 50&#37; of the variation&#46; Presence of current employment was the variable with the greatest impact on functional capacity &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;313&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Clinical and laboratory classic data &#40;joint count&#44; acute-phase reactants and DAS28-4V change&#41; showed no explanatory effect on HRQoL and functional capacity of these patients&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">The present study provides information on the effect of RA on HRQoL and functional capacity&#44; in a real world setting&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Our results corroborate previous studies showing that patients with RA had not only significant physical function and mental health impairment but also poor HRQoL when compared to general Portuguese population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> Differences are particularly notable on physical domains of SF-36 however&#44; RA patients also present levels of mental health subscales significantly lower than general population&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study we verified values of EQ-5D corresponding to states of &#8220;full health&#8221;&#46; Several factors may explain this finding&#46; One of the disadvantages of the EQ5D is that may suffer from ceiling effect&#46; The questionnaire is not sensitive enough to discriminate between different levels of health because the dimensions are probably not sufficiently disaggregated&#44; leading individuals to respond at the highest level&#46; These finding may indicate that individuals with significant morbidity are misclassified as in full health on the EQ-5D descriptive system&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">When we evaluated disease activity influence in HRQoL and functional capacity&#44; we found significant negative correlation &#40;HRQoL and functional impairment with higher disease activity levels&#41;&#46; A interesting finding in our study was to note a stronger correlation between SF-36 and measures of disability and pain &#40;HAQ and VAS-P&#41; than with measures directly related to disease process &#40;ESR&#44; CRP&#44; joint count&#41;&#46; Another finding was the benefit found in these outcomes when REM status was compared directly with LDA&#46; Thus&#44; indicators of quality of life&#44; functional capacity&#44; pain and appreciation of global health patient-reported complementing the clinical evaluation&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">With regard to the potential determinants of these outcomes&#44; we verified that older age and female gender was associated with higher HAQ score&#46; This data confirms previous results&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> Physical function declines with age and it is known that women have lower threshold for pain and that men have more physical strength than women&#46; Current employment was also related to better HAQ scores&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">With regard to HQoL&#44; we identified higher education level and functional capacity as potential determinants&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Unlike other results&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> the duration of disease showed no significant linear relationship with none of the outcomes&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Several limitations of our study should be addressed&#46; We studied a non-representative sample of the Portuguese population&#46; Although the sample was from a reference center of Portugal&#44; this is a convenience sample and the sample size is potentially small&#46; This is a cross-sectional analyses&#59; therefore&#44; prevents to establish directionality of interpretation&#44; i&#46;e&#46;&#44; unknown if group of patients in remission and low disease activity showed better SF-36&#44; EQ-5D and HAQ when presented higher levels of disease activity&#46; Other limitation is the fact that the joint damage was not assessed&#46; This becomes relevant for two reasons&#46; We observed that most patients studied have disease for over 10 years and we know that in late disease the functional capacity is most associated with joint damage&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> The other reason is when we compare our sample with general population and observed that although all domains that compose the PSM were significantly lower&#44; the difference is more pronounced for &#8220;physical functioning&#8221; and &#8220;physical role functioning&#8221; domains than for the &#8220;bodily pain&#8221; domain&#46; Many patients with inactive disease but with important damage have functional limitations but do not refer pain complaints&#46; Finally&#44; the Portuguese population used to compare the HRQoL presents some characteristics that may affect the validity of the results&#46; About 40&#37; of the people interviewed report some type of pathology &#40;namely musculoskeletal&#41;&#46; However&#44; this data has not been clinically confirmed based solely on patient-reported&#46; Data such as gender and age were similar&#46; Most were female and were between 30 and 69 years of age&#46; In this way&#44; we believe that there was no great influence on the results&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Strengths of the present analyses were the inclusion of a sample of patients with a broad range of clinical characteristics&#44; rather than the more homogeneous populations of the trials&#59; the focus on the more-stringent SDAI remission criteria&#44; which allowed the recognition of the differences between REM and all other states&#44; including LDA&#59; it addressed quality of life not only through the state of health &#40;SF-36&#41; but also by assessing the value of health &#40;EQ-5D&#41; reported by the patient&#46; The fact that it included the utility measure will enable future cost-effectiveness studies&#46; Finally&#44; analysis of summary measures of SF-36 as well as each of the domains provides a clearer picture of the dimensions affected by the disease&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">We consider our results useful to better understand the impact of disease and establish a basis for future prospective studies with larger samples to assess the efficacy of therapeutic interventions&#46; The focus on seriously ill patients in need of costly therapy may also be useful for cost-utility analysis studies of biotech drugs&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0235" class="elsevierStylePara elsevierViewall">RA has considerable impact on quality of life and functional capacity being the impairment of HRQoL enormous when compared to general population&#46; We verified lower HRQoL and functional capacity with higher disease activity levels and we saw that reaching remission seems to be a desirable state also from patient perspective&#46; Since the clinical and laboratory data are weakly correlated with HRQoL and functional capacity&#44; we believe that access to PROs is very important in order to complete the disease assessment&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical disclosures</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of human and animal subjects</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Confidentiality of data</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0255" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Authors contributions</span><p id="par0260" class="elsevierStylePara elsevierViewall">All authors make substantial contributions to conception and design&#44; acquisition of data&#44; or analysis and interpretation of data&#46; All critically revise it for important critical content and give final approval of the version of the article accepted for publication&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">None of the authors has any conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the Health related Quality of Life &#40;HRQoL&#41; and physical function in rheumatoid arthritis &#40;RA&#41; patients and compare it with the general population&#46; We also intended to analyze about disease activity influence in HRQoL and functional capacity&#44; as well as determine potential determinants for these outcomes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was conducted in RA patients from a university hospital of Portugal&#46; We obtained Short Form 36&#44; EuroQoL 5D&#44; health assessment questionnaire&#44; visual analog scale for pain and patient&#39;s assessment of disease activity&#46; Comparisons between SF-36 and EQ-5D values with our population reference values were conducted using the Mann&#8211;Whitney test&#46; Data were compared in different levels of disease activity&#44; using Kruskal Wallis test and Fisher&#39;s exact test&#46; A multiple regression analysis was conducted to identify the potential determinants of outcomes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">RA sample showed significantly lower values than the portuguese general population on physical summary measure of SF-36 &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 vs&#46; 50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and EQ-5D &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;620 vs&#46; 0&#46;758 respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Lower disease activity levels had better PROs and this was true even when compared patients achieving remission with those in low disease activity&#46; The HAQ &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#37;&#41;&#44; VAS-P &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#37;&#41; and VAS-DA &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#37;&#41; were the variables that strongly related to SF-36&#46; Considering HAQ&#44; the strongest relation was found with VAS-P&#44; VAS-DA and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#37;&#44; 61&#37; and 33&#37;&#44; respectively&#41;&#46; Multiple regression analysis identified HAQ&#44; VAS-P and educational status as determinants of the HRQoL&#59; age&#44; female gender&#44; employment&#44; VAS-P and VAS-DA as determinants of physical function&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Impairment of HRQoL in RA patients is enormous&#46; We found significant differences between different levels of disease activity&#44; showing higher HRQoL and functional capacity at lower disease activity levels&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la evaluaci&#243;n del Health related Quality of Life &#40;HRQoL&#41; y la funci&#243;n f&#237;sica en pacientes con artritis reumatoide &#40;AR&#41; y compararla con la poblaci&#243;n general&#46; Tambi&#233;n se pretende analizar la influencia de la actividad de la enfermedad en el HRQoL y la capacidad funcional&#44; as&#237; como definir los determinantes potenciales de estos resultados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio transversal en pacientes con AR de un hospital universitario de Portugal&#46; Se obtuvieron los cuestionarios Short Form 36&#44; EuroQol 5D&#44; Health Assessment Questionnaire&#44; la escala anal&#243;gica visual de dolor y la evaluaci&#243;n de la actividad de la enfermedad&#46; Las comparaciones entre los valores de SF-36 y EQ-5D con los valores de referencia de nuestra poblaci&#243;n se conducier&#243;n utilizando el test de Mann-Whitney&#46; Los datos se compararon en diferentes niveles de actividad de la enfermedad utilizando el test de Kruskal Wallis y la prueba exacta de Fisher&#46; Se realiz&#243; un an&#225;lisis de regresi&#243;n m&#250;ltiple para identificar los determinantes potenciales de los resultados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La muestra de AR mostr&#243; valores significativamente m&#225;s bajos que la poblaci&#243;n general portuguesa en la medici&#243;n f&#237;sica de SF-36 &#40;mediana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 vs&#46; 50&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y EQ-5D &#40;mediana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;620 vs&#46; 0&#44;758&#44; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los pacientes con niveles de actividad de la enfermedad m&#225;s bajos tuvieron mejores PRO y esto fue cierto incluso cuando se compararon los pacientes que alcanzaron la remisi&#243;n con aquellos en baja actividad de la enfermedad&#46; El HAQ &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#37;&#41;&#44; VAS-P &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#37;&#41; y VAS-DA &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#37;&#41; fueron las variables fuertemente relacionadas con SF-36&#46; Con respecto a el HAQ&#44; se encontr&#243; una relaci&#243;n m&#225;s fuerte con VAS-P&#44; VAS-DA y la edad &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#37;&#44; el 61 y el 33&#37;&#44; respectivamente&#41;&#46; El an&#225;lisis de regresi&#243;n m&#250;ltiple identific&#243; el HAQ&#44; el VAS-P y el nivel de estudios como determinantes del HRQoL y la edad&#44; el g&#233;nero femenino&#44; el empleo&#44; VAS-P y VAS-DA como determinantes de la funci&#243;n f&#237;sica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El deterioro del HRQoL en los pacientes con AR es enorme&#46; Se encontraron diferencias significativas entre los diferentes niveles de actividad de la enfermedad&#44; mostrando mayor HRQoL y capacidad funcional en niveles m&#225;s bajos de actividad de la enfermedad&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Smoking</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ex-smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Education</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;4th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8211;9th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#8211;12th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;12th grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Work</span> &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Current&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retired &#40;due to disability&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Disease duration &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;2&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">With EAM &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antibodies &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RF and&#47;or ACCP &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RF and ACCP &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Previous cDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Previous bDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Current cDMARDs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">TJC 28</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SJC 28</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CRP &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28 &#40;0&#46;01&#8211;5&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ESR &#40;mm&#47;1&#170;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;1&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">VAS-P&#44; visual analog scales of pain&#59; VAS-GH&#44; visual analog scale for general health&#59; HAQ&#44; Health Assessment Questionnaire&#59; EQ-5D&#44; EuroQol five dimensions questionnaire&#59; SF-36&#44; Short Form Health Survey&#59; PH&#44; physical health&#59; PRF&#44; physical role functioning&#59; BP&#44; bodily pain&#59; GHP&#44; general health perceptions&#59; VT&#44; vitality&#44; SRF&#44; social role functioning&#59; ERF&#44; emotional role functioning&#59; MH&#44; mental health&#59; PSM&#44; physical summary measures&#59; MSM&#44; mental summary measures&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Values presented as medians &#40;range&#41;&#46; P-value between different groups of disease activity by &#42;Mann-Whitney and &#42;&#42; Kruskal-Wallis test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>154&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">REM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value between REM and LDA&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value between all groups&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VAS-P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;0&#8211;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;5 &#40;0&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;50&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VAS-GH</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;20&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;50&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HAQ</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;25 &#40;0&#46;00&#8211;2&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50 &#40;0&#46;00&#8211;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13 &#40;0&#46;00&#8211;2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;63 &#40;0&#46;38&#8211;2&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;00 &#40;1&#46;13&#8211;2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">EQ-5D</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;620 &#40;&#8722;0&#46;349&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;848 &#40;0&#46;708&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;673 &#40;&#8722;0&#46;349&#8211;1&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;516 &#40;&#8722;0&#46;349&#8211;0&#46;812&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;516 &#40;0&#46;053&#8211;0&#46;760&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">SF-36&#58; PH</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;45&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;5&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;5&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;10&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;10&#8211;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GHP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;0&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;35&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;10&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;15&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">SF-36&#58; MH</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;20&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;40&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;20&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;30&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;45&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;3&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;28&#8211;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;13&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;3&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#40;15&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ERF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;28&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;4&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;32&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;14&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;18&#8211;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;15&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;14&#8211;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;14&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;23&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;33&#8211;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;23&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;36&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;43&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;839&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">PSM&#44; physical summary measures&#59; HAQ&#44; Health Assessment Questionnaire&#59; VAS-P&#44; visual analog scales of pain&#59; MSM&#44; mental summary measures&#59; EQ-5D&#44; EuroQol five dimensions questionnaire&#59; VAS-GH&#44; visual analog scale for general health&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Coefficient <span class="elsevierStyleItalic">&#946;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">PSM</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;887<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;424&#8211;7&#46;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher HAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;9&#46;119<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;11&#46;788 to &#8722;6&#46;451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher VAS-P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;165<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;233 to &#8722;0&#46;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">MSM</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8211;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">EQ-5D</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher HAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;208<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher VAS-GH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;003<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;271 to &#8722;0&#46;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;005 to &#8722;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">HAQ</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;003&#8211;0&#46;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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