Illness perceptions account for variation in positive outlook as well as psychological distress in Rheumatoid Arthritis

Abstract

Psychological distress in rheumatoid arthritis (RA) is associated with adverse clinical outcomes, and appears highly related to patients' illness perceptions. This study aimed to investigate the association between illness perceptions, psychological distress, positive outlook and physical outcomes in RA. Two hundred and thirty patients aged >18 years and prescribed at least one disease-modifying anti-rheumatic drug (DMARD) were recruited from outpatient clinics across Hertfordshire (England). Patients completed a questionnaire that assessed psychological distress and positive outlook (depression, anxiety and positive outlook scale), illness perceptions (IPQ-R) and functional disability (health assessment questionnaire). Information regarding prescribed medication and disease activity [disease activity score (DAS28)] was collected from medical notes. Psychological distress, but not positive outlook, was associated with functional disability and DAS28. After controlling for sex, age and DAS28, perceptions of greater symptomatology (identity) and lesser understanding of RA (coherence) were significantly associated with increased psychological distress. Perceptions of greater treatment control were associated with greater positive outlook, but only for those with low DAS28. Coherence was also associated with positive outlook. These findings indicate that illness perceptions may influence psychological distress and positive outlook in RA patients, and may therefore be a useful basis for future psychological interventions.

Patients’ conceptions of their own influence on good treatment response to biological therapy in chronic inflammatory arthritis

“…Evidence regarding the influence of positive mental factors such as optimism in treatment response for patients with CIA is scarce 45. There is, however, a study that indicates that perceptions of treatment control are related to a positive outlook in patients with a low level of disease activity,46 and in a recent study, patients with CIA ranked the importance of keeping a positive attitude as high 47…”

Psychological Distress in Out-Patients Assessed for Chronic Pain Compared to Those with Rheumatoid Arthritis

“…CP patients may experience more pain intensity and psychological distress after they have experienced unsuccessful treatment plans from health care professionals [16]. Psychological distress is associated with poor physical outcomes such as functional disability and pain [27] although the relationship is undoubtedly complex. Tang et al [28] found the presence of mental defeat was a significant predictor of functional disability and distress among individuals with CP.…”

Fears and beliefs of people living with rheumatoid arthritis: a systematic literature review

“…To minimize the patients' feeling of culpability by clarifying wrong beliefs about cause of disease, as well as to reinforce patients' ability to cope with consequences of RA are some strategies that can be adopted by health professionals. Since patients who attribute more symptoms to the rheumatic disease have higher psychological impact, it seems appropriate to help patients to recognize symptoms that are really attributed to RA and to differentiate them from those caused by comorbidities such as depression, anxiety and fibromyalgia [24,28].…”

“…Perceptions of greater symptomatology and greater stress, beliefs on serious consequences of RA, beliefs on lower ability to handle or cope with disease and beliefs on its owns responsibility in the development of RA were reported to amplify the negative emotional impact of disease and contribute to depressive mood and anxiety [24][25][26][27][28][29].…”