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FRI0615-HPR Evaluation of Coping Styles in Established Rheumatoid Arthritis Patients in an Asian Cohort
  1. E. Chew1,
  2. K. Griva1,
  3. P. Cheung2
  1. 1Department of Psychology, National University of Singapore
  2. 2Division of Rheumatology, National University Hospital, Singapore, Singapore


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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