Background In rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA), lifestyle factors such as physical exercise and smoking cessation are beneficial, whereas the impact of dietary factors is debatable. Is there a gap between what is known scientifically and what patients (pts) believe?
Objectives To describe the most frequent lifestyle beliefs of pts with RA or axSpA, and identify the factors associated with erroneous lifestyle beliefs.
Methods In this national cross-sectional study conducted in 2014–2015 in France, pts with RA (ACR/EULAR criteria) or axSpA (ASAS criteria) completed the self-reported “Opinions and fears of pts with chronic inflammatory rheumatism” (QOC-RIC) questionnaire,1 which assessed pt beliefs through 19 questions. Of these, 11 questions were on lifestyle beliefs; each question was scored between 0–10, with 10 indicating “totally agree”. For each lifestyle belief, descriptive analysis reported the percentage of pts with scores ≥7/10 in both RA and axSpA subpopulations. A multiple linear regression model with imputation of missing data explored the association between high levels of beliefs (≥7/10) and pt characteristics (including demographics, social and economic characteristics, disease status, and anxiety/depression levels through the Hospital Anxiety and Depression [HAD] and Arthritis Helplessness Index [AHI] scores).
Results Overall, 672 pts recruited by 100 rheumatologists were analyzed: 432 with RA, 240 with axSpA. For RA and axSpA pts, respectively, 74.0% and 45.2% were female, average age was 58.3 (±13.1) and 47.0 (±13.2) years, and 77.3% and 72.7% were treated with biologics. Mean Disease Activity Score 28 (DAS28[ESR]) was 2.64 (±1.24) in RA pts and mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 3.3 (±2.2) in axSpA pts. The belief (Table) of physical effort triggering flares (P2) was associated with higher anxiety levels (OR=1.80, p=0.005), whereas the opposite belief (P1) was associated with low depression levels (OR=0.56, p=0.007). Beliefs on alcohol (D3) were associated with underprivileged backgrounds (i.e. eligible for minimum social benefits; OR=4.27, p=0.027), whereas the belief on diet (D1) was associated with female gender (OR=2.17, p=0.014).
Conclusions Beliefs about physical activity are varied. Erroneous pt beliefs regarding physical activity were associated with anxiety, indicating that some beliefs may mirror psychological distress. Risks related to smoking were rarely perceived in this population of long-standing pts, and erroneous dietary beliefs were more frequent in female pts and those with underprivileged backgrounds. Physicians need to account for pt beliefs and pursue their educational efforts towards lifestyle modifications.
Gossec L. Ann Rheum Dis 2015;74(S2):323
Acknowledgement The authors acknowledge Costello Medical Consulting, funded by UCB Pharma, for writing and editorial assistance. This study was funded by UCB Pharma and Arthritis Foundation Olivier Courtin.
Disclosure of Interest L. Gossec: None declared, A. Saraux: None declared, P. Chauvin: None declared, M. Poussière: None declared, T. de Chalus Employee of: UCB Pharma, V. Saulot: None declared, F. Russo-Marie: None declared, J. Joubert Employee of: UCB Pharma, C. Hudry: None declared, F. Berenbaum: None declared