Exploring the physical, psychological and social well-being of people with rheumatoid arthritis during the coronavirus pandemic: a single-centre, longitudinal, qualitative interview study in the UK

Abstract

ObjectiveRheumatoid arthritis (RA) is an autoimmune, inflammatory, systemic condition that requires specific drug treatment to suppress disease activity and prevent joint deformity. To manage the ongoing symptoms of joint pain and fatigue patients are encouraged to engage in self-management activities. People with RA have an increased incidence of serious illness and mortality, with the potential to impact on quality of life. This study explored patients’ experiences of living with RA on physical, psychological and social well-being as well as their ability to employ self-management skills during the coronavirus pandemic.DesignQualitative, longitudinal (baseline, 16 September to 23 November 2020 and after 2–4 months, 11 January to the 17 January 2021), semistructured telephone interviews.SettingA rheumatology service based in a community hospital.Participants15 adults with RA.Main outcomesData were analysed using interpretative phenomenological analysis.ResultsFive themes were identified that related to impact on (1) fear: the dominant emotion, (2) social connections and work practices, (3) physical health, (4) identity and (5) self-management as a coping mechanism. The overriding emotion was one of fear, which remained high throughout both interviews. The negative impact on social well-being increased as the pandemic progressed. Conversely, physical health was not affected at either time point, although participants reported difficulty in interpreting whether physical symptoms were attributable to their RA or COVID-19. Recognition of increased vulnerability led to a reassessment of self-identity; however, respondents reported using previously learnt self-management techniques to cope in the context of the pandemic.ConclusionsThe main impact was on emotional and social well-being. Levels of fear and vulnerability which affected self-identity remained high throughout the pandemic and the impact on social well-being increased over time. Physical health remained largely unaffected. Self-management skills were used to maintain a sense of well-being.

Increased Prolonged Sitting in Patients with Rheumatoid Arthritis during the COVID-19 Pandemic: A Within-Subjects, Accelerometer-Based Study

“…Qualitative evidence in patients with rheumatoid arthritis demonstrate that patients reported no changes in physical health outcomes. Conversely, they noted social distancing resulted in worsened mental health-related symptoms [53]. Additionally, changes in these variables did not associate with changes in physical activity and sedentary behavior.…”

Understanding the psychosocial determinants of effective disease management in rheumatoid arthritis to prevent persistently active disease: a qualitative study

“…So, I am going around and around in a cycle looking for ways to improve my [mental and physical] health, but it is harder to [engage in] healthy [RA management] as you have less energy and less ability to stick [to your treatment] because you are focusing on the pain and sadness more. (white woman, [25][26][27][28][29][30][31][32][33][34] Mental and physical well-being practices Practising daily 'positive thinking' was used by participants to cope with their RA symptoms and prognosis, and helps them stay focused on managing their RA. They described using humour, practising positive selftalk, surrounding themselves with positive people and engaging in mindfulness.…”

“…You can overcome the pain by feeling better about yourself and your life. (Black woman, [25][26][27][28][29][30][31][32][33][34] Several used complementary medicine and other pain relief alongside their prescribed RA medical treatment. Regular use of RA medication was perceived to 'have a traumatising effect on the body' and using non-medical treatments was explained as to allow participants to feel in control of their care.…”

Well-being and flourishing mental health in adults with inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis in Manitoba, Canada: a cross-sectional study

“…Open access recent studies have focused on well-being solely in the context of the COVID-19 pandemic. 13 Mental health is not simply the absence of mental illness. 14 Rather, it has been conceptualised as a positive phenomenon; a state of well-being and positive psychological functioning, that is, related to, but distinct from mental illness.…”

“… 10–12 Other recent studies have focused on well-being solely in the context of the COVID-19 pandemic. 13 …”