Background Remission is the core target of disease management in rheumatoid arthritis (RA), but the ultimate goal of medical care is to improve patients’ enjoyment of life, a concept akin to happiness. What is the contribution of disease control towards happiness and what other means may the health professional consider towards that goal?
Objectives To examine the determinants of happiness and quality of life (QoL) in patients with rheumatoid arthritis (RA), with emphasis on disease activity, disease impact and personality traits.
Methods This is an ancillary analysis of an observational, cross-sectional study. Consecutive patients were assessed on disease activity, disease impact, personality, QoL and happiness. Structural equation modelling estimation was used to assess the associations between these dimensions, pursuing three hypotheses: H1 – Disease activity and perceived impact of disease are negatively associated to 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 was analysed. Results obtained in the structural equation measurement model indicated a good fit [χ2/df=1.38; CFI=0.98; GFI=0.92; TLI=0.97; RMSEA=0.04] and supported all three driving hypotheses (figure 1). Happiness was positively related to ‘positive’ personality (total effect of 0.56, with a direct effect of β=0.50, p<0.001 and an indirect effect of β=0.06, p=0.03) and, to a lesser extent, negatively related with perceived impact of disease (β=-0.17; p=0.02). This impact, in turn, was positively related to disease activity (β=0.36; p<0.001) and mitigated by ‘positive’ personality traits (β=-0.37; p<0.001). Impact of disease had a much stronger relation with QoL than with happiness (total effect of 0.72, of which β=-0.02, p=0.04 was an indirect effect vs β=-0.17; p=0.02, respectively). Happiness mitigated the negative effect of disease impact upon QoL (β=0.13; p=0.01). Moreover, disease activity had a negative indirect effect of −0.26 (p=0.003) on QoL and also a negative indirect effect of β=-0.06 (p=0.04) on happiness.
Conclusions Optimisation of QoL and happiness of people with RA requires not only effective control of the disease process but also improvement of the disease impact domains. Personality, and its effects upon the patient’s perception and experience of life, seems to play a pivotal mediating role in these relations and should deserve paramount attention if happiness and enjoyment of life is taken as the ultimate goal of health care.
Disclosure of Interest None declared
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