Background Coping plays an important role in a patient's management of illness. Coping strategies in rheumatoid arthritis (RA) patients have been explored across cultures, but not well-described in an Asian context.
Objectives To examine coping styles adopted by Asian RA patients and their associations with quality of life (QOL).
Methods Cross-sectional evaluation was carried out on consecutive adult patients with established RA (ACR 1987) at a tertiary hospital in Singapore. Data on demographics, disease activity (disease activity score of 28 joints (DAS28)), impact of disease (Rheumatoid Arthritis Impact of Disease, RAID), physical QOL (SF12-PCS) and mental QOL (SF12-MCS) were collected. Aspects related to coping were evaluated using the Coping with Rheumatoid Arthritis Questionnaire (C-RAQ), the level of perceived coping effectiveness and perceived helplessness (numerical rating scales from 0-10). Impaired physical and mental QOL was defined as exceeding 1 standard deviation below the norms of SF12-PCS and SF12-MCS respectively. Statistical analyses included: (i) Categorization of coping strategies: Principal Component Analysis (PCA), (ii) Comparison of coping styles for patients with impaired QOL vs. non-impaired QOL: Mann-Whitney U test, (iii) Relationship/Association of coping styles with QOL: Spearman Rho and Hierarchical Regression.
Results Of the 101 patients included, 72.3% were Chinese, 11.9% Malay and 11.9% Indian. Mean age was 54.2±12.6 years, 81.2% were females, and disease duration was 7.3±7.7 years. The mean DAS28 was 3.4±1.2, RAID was 2.5±2.0, SF12-PCS was 42.7±9.4, and SF12-MCS was 51.2±8.9. Five coping categories were identified: Active Problem Solving (α=0.87, E=5.36), Distancing (α=0.84, E =2.30), Self-Reliance (α=0.79, E =1.89), Cognitive Reframing (α=0.80, E =1.55) and Emotional Expression (α=0.71, E =1.26). Use of Emotional Expression was greater in patients with impaired physical QOL (p<0.001), while Cognitive Reframing was used less in patients with impaired mental QOL compared to those without QOL impairments (p=0.04). Regression models indicated that Emotional Expression was associated with poorer physical QOL (SF12-PCS), after adjusting for DAS28, body mass index, coping effectiveness, helplessness and Self-Reliance (β=-0.39, SE=1.32, p<0.001). Self-Reliance was associated with more impact of disease (RAID) after adjusting for coping effectiveness and helplessness (β=0.22, SE=0.22, p=0.02).
Conclusions Coping strategies such as Emotional Expression and Self-Reliance appear to be used by Asian RA patients, and are associated with poorer physical function and higher impact of disease respectively. Cognitive Reframing was less-used by patients who had poorer mental health scores. Longitudinal evaluation is required to evaluate the impact of these coping strategies in terms of disease-specific and patient-reported outcomes.
Disclosure of Interest None declared
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