Background The relation of physical function to emotional well-being among rheumatoid arthritis (RA) patients has already been investigated in various scientific contributions.Unfortunately, to date, we are still lacking knowledge about the impact of disease-related characteristics (e.g. inflammatory pain or overall disease activity) on the interplay of these characteristics and the ability of coping strategies to buffer physical and emotional impairment.
Objectives To investigate the relation of disease-related outcomes to the interplay of physical function and emotional well-being and to clarify the corresponding role of coping strategies in RA-patients.
Methods A cross-sectional survey among 177 RA-outpatients included the following tools: Health Assessment Questionnaire Disability Index (HAQ-DI), Medical Outcome Studies Short Form 36 Questionnaire (SF-36), the Rheumatoid Arthritis Disease Activity Index (RADAI), Coping with Rheumatoid Arthritis Questionnaire (C-RAQ) and demographic variables – additional information on the DAS28 and the serum status were taken from the patient’s record. Six categories reflecting different levels of impairment in view of physical function and emotional well-being where obtained from plotting the HAQ-DI against the SF-36 mental component summary scale while using a median split for the HAQ-DI (low and increased impairment) and a tertile split for the MCSS (low, moderate, severe impairment). MANOVA and a subsequent discriminant analysis were used to evaluate whether C-RAQ scales and RADAI disease activity characteristics differed between the reference category reflecting least impairment and the remaining categories of impairment.
Results On average, patients were aged 54.78±12.59 yrs and reported a disease duration of 9.42±8.05 yrs whereas 74.6% were female patients. MANOVA revealed a significant general effect (V =0.923, F(50, 595)=2.70, p <0.001) of the combination of physical function and emotional well-being on outcomes of interest. Corresponding post-hoc tests revealed differences in distancing from RA and active problem between the reference category and categories reflecting severe impairment (ppost-hoc =0.04 to 0.001) whereas the current experience of helplessness and disease activity were already more distinctive in categories of moderate and severe combinations of impairment in comparison to the reference category (ppost-hoc =0.034 to 0.001). A discriminant function characterized by helplessness and patient-reported items of disease activity (e.g. overall pain, joint specific duration of morning stiffness or site-specific joint pain) revealed to differentiate best the various levels of impairment in view of physical function and emotional well-being (canonical R2 =0.54).
Conclusions The use of certain coping strategies may have a limited ability to buffer physical and emotional impairment. With a combination of helplessness and disease activity characteristics showing good discriminatory ability in view of the different levels of impairment, these aspects are to be addressed in tailored patient education and self-management programs (including cognitive-behavioral elements) as an add-on to antirheumatic medication. Overcoming or at least modifying the current feeling of helplessness resulting from inflammatory painful conditions should be given utmost attention in this context.
Disclosure of Interest None Declared
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