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Determinants of happiness and quality of life in patients with rheumatoid arthritis: a structural equation modelling approach
  1. Eduardo José Ferreira Santos1,2,3,
  2. Cátia Duarte1,4,
  3. Ricardo J O Ferreira1,3,
  4. Ana Margarida Pinto1,4,
  5. Rinie Geenen5,
  6. Jose A P da Silva1,6
  7. On behalf of the ‘Promoting Happiness Through Excellence of Care’ Group
    1. 1 Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
    2. 2 Escola Superior de Enfermagem do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
    3. 3 Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
    4. 4 Clínica Universitária de Reumatologia, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
    5. 5 Department of Psychology, Utrecht University, Utrecht, The Netherlands
    6. 6 Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine – University of Coimbra, Coimbra, Portugal
    1. Correspondence to Professor Jose A P da Silva, Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-076, Portugal; jdasilva{at}


    Objectives Besides increasing longevity, the ultimate goal of medical care is to improve patients’ enjoyment of life, a concept akin to happiness. This study examined the determinants of happiness and quality of life (QoL) in patients with rheumatoid arthritis (RA).

    Methods In this observational, cross-sectional study, patients were assessed on disease activity, disease impact, personality, QoL and happiness. Structural equation modelling estimation was used to analyse the associations between these dimensions, pursuing three hypotheses: H1—disease activity and perceived impact of disease are negatively associated with overall QoL and happiness in patients with RA; H2—‘positive’ personality traits are related to happiness both directly and indirectly through perceived disease impact; H3—happiness has a mediating effect in the relation between impact of disease and QoL.

    Results Data from 213 patients were analysed. Results supported all driving hypotheses. Happiness was positively related to ‘positive’ personality and, to a lesser extent, negatively related to impact of disease. Impact of disease, in turn, was positively related to disease activity and mitigated by ‘positive’ personality traits. Impact of disease had a much stronger relation with QoL than with happiness. Happiness mitigated the negative effect of disease impact on QoL.

    Conclusion Optimisation of QoL and happiness of people with RA requires effective control of the disease process and also improvement of the disease impact domains. Personality seems to play a pivotal mediating role in these relations.

    • rheumatoid arthritis
    • patient perspective
    • outcomes research

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    • Handling editor Josef S Smolen

    • Contributors EJFS performed the statistical analyses (assisted by RJOF and AMP) and wrote the manuscript. CD, RJOF and JAPdS designed the study. AMP and RG revised the final manuscript from their respective specialist perspective. JAPdS supervised and contributed to all steps of the work. All members of the ‘Promoting Happiness Through Excellence of Care ’ contributed through inspiring discussions on the topic of happiness and medical care, through examining and interviewing patients and revising the manuscript. Co-authors: “Promoting Happiness Through Excellence of Care” is the registered moto of the Rheumatology Department at the Faculty of Medicine and University Hospital of Coimbra. Additional members of this group: Alexandra Daniel, Ana Pinto, Anabela Silva, Andréa Marques, Armando Malcata, Carlos Costa, Cristiana Silva, Diogo Jesus, Flávio Costa, Gisela Eugénio, João Freitas, João Rovisco, Jorge Silva, José Laranjeiro, Luísa Brites, Margarida Coutinho, Maria Salvador, Mariana Luís, Mariana Santiago, Marília Rodrigues, Mary Marques, Pedro Carvalho, Pedro Freitas, Sara Serra, Tânia Santiago.

    • Funding No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University of Coimbra’s Faculty of Medicine Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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