Distress in Rheumatoid Arthritis: Then and Now

Individuals living with rheumatoid arthritis (RA) today experience significantly less psychological distress and physical disability than those who were living with the autoimmune disease two decades ago, according to new research from the Netherlands.

“The results of our study relay the hopeful message to patients that today, in spite of having RA, they have a better opportunity to live a full and valued life than 20 years ago,” said lead author, Cécile L. Overman, MSc, PhD Candidate, Department of Clinical and Health Psychology, Utrecht University, Netherlands.

She acknowledged that their findings are good news for healthcare professionals and rheumatologists in particular. “It seems we’re on the right track by focusing more on the whole patient, not just the disease, but also the person’s mental and physical well-being and by implementing the improved treatment strategies,” she said.

These modifications in treatment focus and strategy that have been implemented over the years include more physical activity and earlier, more intensive and aggressive pharmacologic treatment for patients with RA, as noted in the study.

According to Overman, studies investigating the psychological well-being of patients with RA over time are scarce. Rather than examining only the physical changes experienced by individuals with RA over time, they focused on differences in both psychological well-being and physical functioning “to give a more complete view of how the quality of life of patients with RA has evolved over the past decades,” she said.

“Our study is the first to examine changes in physical disability and psychological distress over such a long period of time (21 years); the first to examine if a reduction in disease activity could, at least in part, explain the changes; and the first to cover recent years so effects of the newest treatments could be observed,” she added.

Overman also pointed out their study differed from previous research in that these changes were analyzed over annual cohorts of patients with a uniform disease duration. “Therefore, in contrast with other cross-sectional population studies, the effect of year of assessment was not confounded by disease duration.”

The authors analyzed data on 1151 patients (aged 17-86 years) who were diagnosed with RA between 1990 to 2011. The participants were assessed for depression, anxiety, and physical disability when they were first diagnosed and then again after 3 to 5 years of treatment.

After 4 years of treatment, depression, anxiety, and physical disability were experienced by 25%, 23%, and 53% of patients with RA 20 years ago and only 14%, 12%, and 31% of patients with RA today.

In addition, researchers concluded that the improvements seen in physical disability and psychological distress over the years may be due in part to reduced disease activity.

Some limitations of the study as described by Overman include the fact that their analysis only involved patients with recent RA diagnoses from areas that have implemented improved treatment strategies over the years and that have national health systems that provide all patients with access to the same quality of patient care.

“The clinical burden of RA is still substantial for many patients, especially in less prosperous countries,” she said.

Researchers also did not examine the influences of specific treatment modalities (all participants received treatment according to the guidelines at that time). In addition, Overman explained that the type of study design prohibited them from being able to definitively establish reduced disease activity as a cause of reduced psychological distress and physical disability or take into account potential confounding factors related to patient characteristics that changed over the two decades.

“Earlier diagnosis, more intensive interventions, and the use of new effective anti-inflammatory drugs such as the biologicals alongside recommendations to live a full life and to be physically active may have helped to improve daily living for patients with RA,” she stated. This study was published in Arthritis Care & Research.

-Meredith Edwards White

Reference:

Overman CL, Jurgens MS, Bossema ER, Jacobs JW, Bijlsma JW, Geenen R. Patients with rheumatoid arthritis nowadays are less psychologically distressed and physically disabled than patients two decades ago. Arthritis Care Res (Hoboken). 2013 Dec 3. doi: 10.1002/acr.22211. [Epub ahead of print]