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Impact of rheumatoid arthritis on the quality of life and its relation to disease activity
Egyptian Rheumatology and Rehabilitation volume 46, pages 304–312 (2019)
Quality of life (QOL) is a multidimensional concept that is used to describe the individuals’ perceptions, satisfaction, and evaluation of different areas of their own lives, such as physical health and functioning, psychological and emotional well-being, social roles, and relationships. Few studies have addressed the effect of rheumatoid disease on the QOL in the Egyptian community.
Functional disability based on health assessment questionnaire disability index was significantly increased with the increase in disease activity based on disease activity score-28, where all patients on remission and 56% of those with low disease activity had mild functional disability. Approximately 89% of patients with low disease activity had mild anxiety based on Hamilton anxiety scale, and the majority (75%) of those patients with moderate disease activity and 83.3% of patients on remission had mild anxiety. The majority (85.7%) of those with high disease activity were depressed based on Zung self-rating depression score. Disease activity score-28 score had a positive significant correlation with health assessment questionnaire disability index (P=0.01, r=0.40), Hamilton anxiety scale-A (P=0.01, r=0.46), Zung score (P=0.01, r=0.46), and rheumatoid arthritis QOL (r=0.70, P=0.00), and negative correlation with female sexual index (r=-0.80, P=0.00), all domains of SF-36, and all five domains of WHOQOL.
This study confirms that rheumatoid arthritis causes impairment of all aspects of QOL (limitation of physical function, physical disability, and pain), mental health disorders (anxiety and depression), and social, environmental, and also sexual dysfunction.
Palferman TG. Principles of rheumatoid arthritis control. J Rheumatol Suppl 2003; 67:10–13.
Chorus A, Miedema H, Boonen A, van Der Linden S. Qualityoflife and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 2003; 62:1178–1184.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2163–2196.
Wan G, Counte M, Cella D. A framework for organizing health-related quality of life research. J Rehabil Outcomes Meas 1997; 1:31–37.
Mathew A, Antony J, Eremenco S, Paul B, Jayakumar B, Philip J. Health-related quality of life in rheumatoid arthritis patients in South India. Singapore Med J 2009; 50:800.
Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982; 1:61.
Uhlig T, Loge JH, Kristiansen IS, Kvien TK. Quantification of reduced health-related quality of life in patients with rheumatoid arthritis compared to the general population. J Rheumatol 2007; 34:1241–1247.
Yaghoubi A, Tabrizi JS, Mirinazhad MM, Azami S, Naghavi-Behzad M, Ghojazadeh M. Quality of life in cardiovascular patients in Iran and factors affecting it: a systematic review. J Cardiovasc Thorac Res 2012; 4:95.
Tosa EE, Albu A, Popa M. The effect of physical therapy on the improvement of the quality of life in rheumatoid arthritis patients. Civil Sport 2016; 17:29–34.
Uhlig T, Moe RH, Kvien TK. The burden of disease in rheumatoid arthritis. Pharmacoeconomics 2014; 32:841–851.
Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989; 27:S217–S232.
Damiano AM, Steinberg EP, Cassard SD, Bass EB, Diener-West M, Legro MW, et al. Comparison of generic versus disease-specific measures of functional impairment in patients with cataract. Med Care 1995; 33: AS120–AS130.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European 104 League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69:1580–1588.
Heinimann K, von Kempis J, Sauter R, Schiff M, Sokka-Isler T, Schulze-Koops H, et al. Long-term increase of radiographic damage and disability in patients with RA in relation to disease duration in the era of biologics. Results from the SCQM cohort. J Clin Med 2018; 7:57.
Zeman MN, Scott PJ. Current imaging strategies inrheumatoid arthritis. Am J Nucl Med Mol Imaging 2012; 2:174.
Hussein WA. The quality of life in patients with rheumatoid arthritis in Baghdad, 2017: a cross-sectional study. Int J Med Res Health Sci 2017; 6:20–34.
Kojima M, Kojima T, Ishiguro N, Oguchi T, Oba M, Tsuchiya H, et al. Psychosocial factors, disease status, and quality of life in patients with rheumatoid arthritis. J Psychosom Res 2009; 67:425–431.
Karpouzas GA, Draper T, Moran R, Hernandez E, Nicassio P, Weisman MH, et al. Trends in functional disability and determinants of clinically meaningful change over time in hispanic patients with rheumatoid arthritis in the US. Arthritis Care Res (Hoboken) 2017; 69:294–298.
Da Rocha Castelar Pinheiro P, Khandker R, Sato R, Rose A, Piercy J. Impact of rheumatoid arthritis on quality of life, work productivity and resource utilisation: an observational, cross-sectional study in Brazil. Clin Exp Rheumatol 2013; 31:334–340.
Scott DL. Radiological progression in established rheumatoid arthritis. J Rheumatol Suppl 2004; 69:55–65.
VanDyke MM, Parker JC, Smarr KL, Hewett JE, Johnson GE, Slaughter JR, et al. Anxiety in rheumatoid arthritis. Arthritis Rheum 2004; 51:408–412.
Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009; 190:S54.
Hawley D, Wolfe F. Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients. J Rheumatol 1988; 15:932–941.
Bradley LA, Young LD, Anderson KO, Turner RA, Agudelo CA, Mcdaniel LK, et al. Effects of psychological therapy on pain behavior of rheumatoid arthritis patients. Treatment outcome and six-month follow up. Arthritis Rheum 1987; 30:1105–1114.
Smedstad L, Vaglum P, Moum T, Kvien T. The relationship between psychological distress and traditional clinical variables: a 2 year prospective study of 216 patients with early rheumatoid arthritis. Br J Rheumatol 1997; 36:1304–1311.
Guyatt GH. Measurement of health-related quality of life in heart failure. J Am Coll Cardiol 1993; 22:A185–A191.
Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med 2002; 64:52–60.
Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: asystematic review and meta-analysis. Rheumatology 2013; 52:2136–2148.
Sunar I, Garip Y, Yilmaz O, Bodur H, Ataman S. Disease activity (rheumatoid arthritis disease activity index-5) in patients with rheumatoid arthritis and its association with quality of life, pain, fatigue, and functional and psychological status. Arch Rheumatol 2015; 30:144–150.
Cadena J, Vinaccia S, Pérez A, Rico MI, Hinojosa R, Anaya JM. The impact of disease activity on the quality of life, mental health status, and family dysfunction in colombian patients with rheumatoid arthritis. J Clin Rheumatol 2003; 9:142.
Prajs K, Flicinski J, Brzosko I, Przepiera-Bedzak H, Ostanek L, Brzosko M. Quality of life and activity of disease in patients with rheumatoid arthritis. InAnnales Academiae Medicae Stetinensis 2006; 52:39–43.
Lankveld WV, Ruiterkamp G, Näring G, Rooij DD. Marital and sexual satisfaction in patients with RA and their spouses. Scand J Rheumatol 2004; 33:405–408.
Abdel-Nasser AM, Ali EI. Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis. Clin Rheumatol 2006; 25:822–830.
El Miedany Y, El Gaafary M, El Aroussy N, Youssef S, Ahmed I. Sexual dysfunction in rheumatoid arthritis patients: arthritis and beyond. Clin Rheumatol 2012; 31:601–606.
Shahar MA, Hussein H, Sidi H, Shah SA, Mohamed Said MS. Sexual dysfunction and its determinants in Malaysian women with rheumatoid arthritis. Int J Rheum Dis 2012; 15:468–477.
Coskun B, Coskun BN, Atis G, Ergenekon E, Dilek K. Evaluation of sexual function in women with rheumatoid arthritis. Urol J 2014; 10:1081–1087.
Frikha F, Maazoun F, Ben RS, Snoussi M, Masmoudi J, Nabil MM, et al. Sexual function in married women with rheumatoid arthritis. Presse Med 2011; 40:e521–e527.
Yilmaz H, Polat HAD, Yilmaz SD, Erkin G, Kucuksen S, Salli A, et al. Evaluation of sexual dysfunction in women with rheumatoid arthritis: a controlled study. J Sex Med 2012; 9:2664.
Al-Fadl EMA, Ismail MA, Thabit M, El-Serogy Y. Assessment of health-related quality of life, anxiety and depression in patients with early rheumatoid arthritis. Egypt Rheumatol 2014; 36:51–56.
Birrell F, Hassell A, Jones P, Dawes P. How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relate to RA outcome measures and SF-36 population values? A cross-sectional study. Clin Rheumatol 2000; 19:195–199.
Skevington SM, Lotfy M, O’Connell KA. The World Health Organization ‘s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004; 13:299–310.
Taylor WJ, Myers J, Simpson RT, McPherson KM, Weatherall M. Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF): Score distributions and psychometric properties. Arthritis Rheum 2004; 51:350–357.
Strömbeck B, Ekdahl C, Manthorpe R, Wikström I, Jacobsson L. Health-related quality of life in primary Sjögren’s syndrome, rheumatoid arthritis and fibromyalgia comparedto normal population data using SF-36. Scand J Rheumatol 2000; 29:20–28.
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Goma, S.H., Razek, M.R.A. & Abdelbary, N.M. Impact of rheumatoid arthritis on the quality of life and its relation to disease activity. Egypt Rheumatol Rehabil 46, 304–312 (2019). https://doi.org/10.4103/err.err_39_19
- disease activity score
- quality of life
- rheumatoid arthritis