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Nottingham health profile questionnaire incorporates important aspects of the patient perspective into outcome assessment in rheumatoid arthritis.

OBJECTIVE
There is a consensus on the need for a more thorough assessment of outcome of RA from the perspective of those who experience the disease. Our objective was to assess the health- related quality of life (HR-QOL) of RA patients by the Nottingham Health Profile (NHP), the measurement of subjective experienced distress.


METHODS
One hundred and nineteen consecutive out-patients were cross-sectionally assessed. HR-QOL was evaluated by using the first section of the NHP, a generic quality of life instrument, that assess subjective distress on six dimensions: mobility, pain, energy, sleep, emotional reaction and social isolation. Functional capacity was measured by the Health Assessment Questionnaire (HAQ).


RESULTS
The NHP scores for mobility, pain, energy and sleep showed a linear association (p<0.001 for each) with HAQ disability level. In addition to pain, patients with mild disability (HAQ 0-1) may suffer from remarkable fatigue (loss of energy) and problems in sleep. Even at the HAQ level 0, there was some perceived distress in almost all of the NHP dimensions.


CONCLUSIONS
Poor HAQ levels were associated with patient perceived distress in dimensions which are getting minor attention in clinics, i.e., energy and sleep. It is to be noted that RA patients who reported no disability or its lowest levels measured by HAQ perceived notable distress in many NHP dimensions. Our results suggest that NHP is a potential candidate for a HR-QOL questionnaire which should considered to be used in routine clinical assessment of RA patients.