Determinants of happiness and quality of life in patients with rheumatoid arthritis: a structural equation modelling approach

Abstract

ObjectivesBesides 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).MethodsIn 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.ResultsData 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.ConclusionOptimisation 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.

Shared decision‐making in people with chronic disease: Integrating the biological, social and lived experiences is a key responsibility of nurses

“…Many chronic conditions, such as rheumatic diseases, are characterized by a deregulated immune system that primarily affects a specific organ (Chen et al, ; Schultze & Rosenstiel, ) and can severely affect all areas of life, including physical, social and psychological well‐being (Santos, Duarte, et al, ; Taylor, Moore, Vasilescu, Alvir, & Tarallo, ). Developments in pharmacological treatments over the last two decades have revolutionized the management of many of these conditions, effectively reducing the inflammatory process and keeping it low or in remission.…”

“…Our recent research has highlighted that each patient has a unique perception of his/her disease (Santos, Duarte, et al, ). Personality traits have a considerable influence on the perception of the disruption caused by the disease, with decisive consequences on QoL and happiness (Santos, Duarte, et al, ).…”

Overdiagnosis and overtreatment in rheumatology: a little caution is in order

“…Strategy trials may have proven the feasibility of intensive monitoring and treat-to-remission, but their surplus efficacy on radiographic progression was minimal or absent 13–15. The question if the difference between zero and minimal structural progression really adds value to the patients, given the totality of factors that contribute to ‘happy patients’,16 has not been answered by these trials. What we have learnt, though, is that drug use in patients who were intensively monitored and steered towards remission was markedly higher than in patients treated regularly—a subtle sign of overtreatment.…”

“…Unfortunately, many researchers, clinicians and the public are not appropriately educated to interpret prognostic (risk) information and grossly overestimate its value. We still do not know about the most important health outcomes to patients, namely those outcomes that truly add value and that we should actually be able to predict 16. Diagnosis and treatment based on unreliable prognostic markers will inevitably lead to overdiagnosis and overtreatment in a number of patients.…”

“…We need trials investigating how to best manage all those milder cases that come to us as a result of our early diagnosis initiatives. We need to learn what does and does not really matter to patients with inflammatory rheumatic diseases 16. We need to pay more attention to possible overdiagnosis and overtreatment in our clinical research.…”