Impact of Psychological Factors on Subjective Disease Activity Assessments in Patients With Severe Rheumatoid Arthritis

Abstract

ObjectiveThe Disease Activity Score in 28 joints (DAS28), used to assess disease activity in rheumatoid arthritis (RA), is a composite score comprising clinical, biochemical, and patient self-report measures. We hypothesized that psychological factors (cognitions and mood) would be more strongly associated with patient-reported components of the DAS28 than clinical or biochemical components.MethodsA cross-sectional, observational study of 322 RA patients with active disease (mean DAS28 6.0) awaiting therapy with a biologic agent was undertaken. Patients' illness beliefs, treatment beliefs, and mood were measured using the Brief Illness Perception Questionnaire (IPQ), the Beliefs about Medicines Questionnaire (BMQ), and the Hospital Anxiety and Depression Scale (HADS), respectively. Relationships between psychological factors and 1) total DAS28 and 2) individual components of the DAS28 were analyzed using linear regression.ResultsTotal DAS28 produced significant but weak associations with 2 of the Brief IPQ items, but no associations with BMQ or HADS scores. There were larger significant associations between the patient-reported visual analog scale (VAS) with 5 items of the Brief IPQ and with HADS depression. Low illness coherence was associated with higher tender joint count. Three Brief IPQ items and HADS anxiety scores were significantly associated with C-reactive protein level or erythrocyte sedimentation rate. No psychological factors were associated with the swollen joint count.ConclusionOne of the subjective components of the DAS28, patient VAS, was highly correlated with cognitive factors and depression in those with severe RA. By reporting individual DAS28 components, clinicians may be better able to assess the impact of therapies on each component, adjusting approaches according to patients' needs.

Are Illness Perceptions Associated With Disease Activity or Psychological Well-Being in Rheumatoid Arthritis? A Study With the Evidence of Confirmatory Factor Analysis

“…5,6,[32][33][34] However, these relationships were not found in our study. In the literature, there are a few studies investigating the relationship between illness perceptions and disease activity in RA and the results are contradictory.…”

“…13 In RA patients, illness perceptions have shown association with disease activity, pain, disability, quality of life, depression, and anxiety. [5][6][7][8] The results of the studies reveal that how the patients perceive their RA has an impact on disease outcome, and RA is more serious in patients with negative beliefs about their illness. 5,6 The Revised Illness Perception Questionnaire (IPQ-R) has been used extensively for the assessment of illness perception.…”

“…[5][6][7][8] The results of the studies reveal that how the patients perceive their RA has an impact on disease outcome, and RA is more serious in patients with negative beliefs about their illness. 5,6 The Revised Illness Perception Questionnaire (IPQ-R) has been used extensively for the assessment of illness perception. 14 The reliability and validity of the Turkish IPQ-R was performed by Armay et al 15 in cancer patients.…”

“…There have been reports on the illness perceptions in several diseases such as RA, [5][6][7][8] ankylosing spondylitis, 4 fibromyalgia, 9 sport injuries, 10 low back pain, 11 osteoarthritis, 12 and chronic fatigue syndrome. 13 In RA patients, illness perceptions have shown association with disease activity, pain, disability, quality of life, depression, and anxiety.…”

Law of the Vital Few: Choosing Variables of Disease Activity in Rheumatoid Arthritis

“…The most obvious limitation of the DAS is that tender joint count and patient visual analog scales (VAS) may reflect other pathologies and patient states, including osteoarthritis, secondary damage, psychological factors, and fibromyalgia 5,6 . The DAS was first derived in early arthritis clinics in an era of ineffective therapies, when most symptomatic patients had some active inflammation.…”