Abstract
Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory disease that significantly reduces the quality of life (QOL) of affected patients. Many studies have emphasized the deterioration of QOL during the treatment of patients with RA, but factors that affect this phenomenon in Koreans with RA remain unclear.
Methods
In this cross-sectional study, 166 Korean patients with RA were enrolled, and their general characteristics, disease-related characteristics, fatigue, feelings of depression, self-efficacy, social support, and QOL were assessed.
Results
The overall mean score for RA-specific QOL was 5.8 out of 10. Fatigue, depression, self-efficacy, and social support were found to be significantly associated with the QOL of patients with RA. Notably, self-efficacy was found to be the most significant predictor of QOL.
Conclusions
Compared to patients with RA in Western countries, Korean patients with RA, even those with better physical function, seem to have a lower QOL. Identification of the relevant physical, psychological, and social factors affecting QOL in Koreans with RA is beneficial for clinical practice. Incorporation of strategies to address these factors, such as cognitive behavioral therapy, should be considered for the holistic management of RA.
Key Points • Korean patients with RA report lower levels of QOL. • Factors associated with the QOL of patients with RA were fatigue, depression, self-efficacy, and social support. • Self-efficacy was the strongest factor affecting QOL in this population; thus, it would be beneficial for clinical practitioners to incorporate cognitive-behavioral approaches into patient education to enhance self-management. • Our findings suggest that QOL and psychological factors should also be regularly evaluated for the holistic management of patients with RA. |
Similar content being viewed by others
Data availability
Available on request.
Code availability
Not applicable.
References
Linde L, Sørensen J, Østergaard M, Hørslev-Petersen K, Hetland-Lund M (2008) Health-related quality of life: validity, reliability, and responsiveness of SF-36, EQ-15D, EQ-5D, RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol 35(8):1528–1537
Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet (London, England) 376(9746):1094–1108. https://doi.org/10.1016/S0140-6736(10)60826-4
Alishiri GH, Bayat N, Salimzadeh A, Salari A, Hosseini SM, Rahimzadeh S et al (2011) Health-related quality of life and disease activity in rheumatoid arthritis. Int J Res Med Sci 16(7):897–903
Murillo YA, Almagro RM, Campos-González ID, Cardiel MH (2015) Health related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects Experience from a General Hospital in Mexico. Reumatol Clin. 11(2):68–72. https://doi.org/10.1016/j.reuma.2014.03.006
Gong G, Mao J (2016) Health-related quality of life among Chinese patients with rheumatoid arthritis: the predictive roles of fatigue, functional disability, self-efficacy, and social support. Nurs Res 65(1):55–67. https://doi.org/10.1097/nnr.0000000000000137
Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Norton S, et al. editors (2014) The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum. https://doi.org/10.1016/j.semarthrit.2014.05.001
Michaud K, Vera-Llonch M, Oster G (2012) Mortality risk by functional status and health-related quality of life in patients with rheumatoid arthritis. J Rheumatol 39(1):54–59. https://doi.org/10.3899/jrheum.110491
Singh JA, Nelson DB, Fink HA, Nichol KL (2005) Health-related quality of life predicts future health care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study. Semin Arthritis Rheum. https://doi.org/10.1016/j.semarthrit.2004.08.001
Baillet A, Zeboulon N, Gossec L, Combescure C, Bodin LA, Juvin R et al (2010) Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 62(7):984–92. https://doi.org/10.1002/acr.20146
Uhlig T, Moe RH, Kvien TK (2014) The burden of disease in rheumatoid arthritis. Pharmacoeconomics 32(9):841–851. https://doi.org/10.1007/s40273-014-0174-6
Silva CF, Duarte C, Ferreira RJ, Santos E, da Silva JAP (2019) Depression, disability and sleep disturbance are the main explanatory factors of fatigue in rheumatoid arthritis: a path analysis model. Clin Exp Rheumatol 38:314–321
Zhang L, Xia Y, Zhang Q, Fu T, Yin R, Guo G et al (2017) The correlations of socioeconomic status, disease activity, quality of life, and depression/anxiety in Chinese patients with rheumatoid arthritis. Psychol Health Med 22(1):28–36. https://doi.org/10.1080/13548506.2016.1198817
Margaretten M, Julian L, Katz P, Yelin E (2011) Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol 6(6):617. https://doi.org/10.2217/ijr.11.6
Zhang L, Cai P, Zhu W (2020) Depression has an impact on disease activity and health-related quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Int J Rheum Dis 23(3):285–293. https://doi.org/10.1111/1756-185X.13774
Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E et al (2016) Role of sleep disturbance, depression, obesity, and physical inactivity in fatigue in rheumatoid arthritis. Arthritis Care Res (Hoboken) 68(1):81–90
Vallerand IA, Patten SB, Barnabe C (2019) Depression and the risk of rheumatoid arthritis. Curr Opin Rheumatol 31(3):279–284. https://doi.org/10.1097/bor.0000000000000597
Martinez-Calderon J, Meeus M, Struyf F, Luque-Suarez A (2020) The role of self-efficacy in pain intensity, function, psychological factors, health behaviors, and quality of life in people with rheumatoid arthritis: A systematic review. Physiother Theory Pract 36(1):21–37. https://doi.org/10.1080/09593985.2018.1482512
Pitsilka DA, Kafetsios K, Niakas D (2015) Social support and quality of life in patients with rheumatoid arthritis in Greece. Clin Exp Rheumatol 33(1):27–33
Aga A-B, Lie E, Uhlig T, Olsen IC, Wierød A, Kalstad S, et al (2015) Time trends in disease activity, response and remission rates in rheumatoid arthritis during the past decade: results from the NOR-DMARD study. Ann Rheum Dis. 2000–2010 74(2):381–8. https://doi.org/10.1136/annrheumdis-2013-204020
Aletaha D, Smolen JS (2018) Diagnosis and management of rheumatoid arthritis: a review. JAMA 320(13):1360–1372. https://doi.org/10.1001/jama.2018.13103
Fausto S, Di Carlo Marco CM, Sonia F, Alessandro C, Marwin G (2018) The impact of different rheumatic diseases on health-related quality of life: a comparison with a selected sample of healthy individuals using SF-36 questionnaire, EQ-5D and SF-6D utility values. Acta Biomed. 89(4):541. https://doi.org/10.23750/abm.v89i4.7298
Riegel B, Moser DK, Rayens MK, Carlson B, Pressler SJ, Shively M et al (2008) Ethnic differences in quality of life in persons with heart failure. J Card Fail 14(1):41–47. https://doi.org/10.1016/j.cardfail.2007.09.008
Megari K (2013) Quality of life in chronic disease patients. Health Psychol Res. 1(3):e27-e. https://doi.org/10.4081/hpr.2013.e27
Cho SK, Kim D, Jun JB, Bae SC, Sung YK (2013) Factors influencing quality of life (QOL) for Korean patients with rheumatoid arthritis (RA). Rheumatol Int 33(1):93–102. https://doi.org/10.1007/s00296-011-2352-6
Uhm DC, Nam ES, Lee HY, Lee EB, Im Yoon Y, Chai GJ (2012) Health-related quality of life in Korean patients with rheumatoid arthritis: association with pain, disease activity, disability in activities of daily living and depression. J Korean Acad Nurs. 42(3). https://doi.org/10.4040/jkan.2012.42.3.434
Danao LL, Padilla GV, Johnson DA (2001) An English and Spanish quality of life measure for rheumatoid arthritis. Arthritis Rheum 45(2):167–173. https://doi.org/10.1002/1529-0131(200104)45:2%3C167::AID-ANR170%3E3.0.CO;2-X
Song SW, Kang SG, Kim KS, Kim MJ, Kim KM, Cho DY et al (2018) Reliability and validity of the Korean version of the multidimensional fatigue inventory (MFI-20): a multicenter, cross-sectional study. Pain Res Manag 2018:3152142. https://doi.org/10.1155/2018/3152142
Smets EM, Garssen B, Bonke B, De Haes JC (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 39(3):315–25. https://doi.org/10.1016/0022-3999(94)00125-O
Shin SC, Kim MK, Yun KS, Kim JH, Lee MS, Moon SJ et al (1991) The center for epidemiologic studies-depression scale: its use in Korea. JKNA 30(4):752–767
Lorig K, Chastain RL, Ung E, Shoor S, Holman HR (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 32(1):37–44. https://doi.org/10.1002/anr.1780320107
Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The multidimensional scale of perceived social support. J Pers Assess 52(1):30–41
Park H, Nguyen T, Park H (2012) Validation of multidimensional scale of perceived social support in middle-aged Korean women with diabetes. Asia Pac J Soc Work 22(3):202–213
Pincus T, Swearingen C, Wolfe F (1999) Toward a multidimensional health assessment questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum 42(10):2220–2230. https://doi.org/10.1002/1529-0131(199910)42:10%3C2220::AID-ANR26%3E3.0.CO;2-5
Jhita T, Petrou S, Gumber A, Szczepura A, Raymond NT, Bellary SJH et al (2014) Ethnic differences in health related quality of life for patients with type 2 diabetes. Health Qual Life Outcomes 12(1):1–10. https://doi.org/10.1186/1477-7525-12-83
Garip Y, Eser F, Bodur H (2011) Health-related quality of life in rheumatoid arthritis: comparison of RAQoL with other scales in terms of disease activity, severity of pain, and functional status. Rheumatol Int 31(6):769–772. https://doi.org/10.1007/s00296-009-1353-1
Sanderson T, Morris M, Calnan M, Richards P, Hewlett S (2010) Patient perspective of measuring treatment efficacy: the rheumatoid arthritis patient priorities for pharmacologic interventions outcomes. Arthritis Care Res (Hoboken) 62(5):647–656. https://doi.org/10.1002/acr.20151
Suh CH, Jung JY, Oh H, Boo S (2019) Evaluation of factors affecting the levels of physical activity in patients with rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 38(9):2483–2491. https://doi.org/10.1007/s10067-019-04559-5
Bandura A (1989) Regulation of cognitive processes through perceived self-efficacy. Dev Psychol 25(5):729–735
Knittle KP, De Gucht V, Hurkmans EJ, Vlieland TP, Peeters AJ, Ronday HK et al (2011) Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 63(11):1613–1619. https://doi.org/10.1002/acr.20587
White CA (2001) Cognitive behaviour therapy for chronic medical problems: a guide to assessment and treatment in practice. John Wiley & Sons Ltd, London
Hewlett S, Ambler N, Almeida C, Cliss A, Hammond A, Kitchen K et al (2011) Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy. Ann Rheum Dis 70(6):1060–1067. https://doi.org/10.1136/ard.2010.144691
Shen B, Li Y, Du X, Chen H, Xu Y, Li H et al (2020) Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis. Psychol Health Med 25(10):1179–1191. https://doi.org/10.1080/13548506.2020.1736312
Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE (2010) Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 62(6):1576–1582. https://doi.org/10.1002/art.27425
Funding
This work was supported by a grant from the National Research Foundation of Korea (NRF) funded by the Korea government (Ministry of Science and ICT & Future Planning) (no. 2017R1C1B1010892) and by the research fund of Ajou University College of Nursing (M2020C046000080).
Author information
Authors and Affiliations
Contributions
Conceptualization: CHS, JWK, SB.
Data curation: CHS, JWK, SB.
Formal analysis: SB.
Funding acquisition: SB.
Investigation: CHS, SB.
Project administration: SB.
Resources: SB.
Supervision: CHS, SB.
Writing of the original draft: CHS, KL, SB.
Writing and/or reviewing and editing: CHS, JWK, KL, SB.
Corresponding author
Ethics declarations
Ethics approval
Approved by the appropriate ethics review board and, therefore, performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Consent to participate
All persons provided informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study have been omitted.
Consent for publication
All authors agree to submit this draft to Clinical Rheumatology.
Disclosures
None.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Suh, CH., Lee, K., Kim, JW. et al. Factors affecting quality of life in patients with rheumatoid arthritis in South Korea: a cross-sectional study. Clin Rheumatol 41, 367–375 (2022). https://doi.org/10.1007/s10067-021-05944-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-021-05944-9