RA Significantly Impairs Physical, Psychosocial Functioning

Living with rheumatoid arthritis (RA) was shown to significantly impair a patient’s health-related quality of life (HRQoL) regarding both physical and psychosocial functioning, according to a study published in BMJ Open.¹ Additionally, as a strong correlation between clinical activity and HRQoL scores was observed, investigators believe the Five-Level EuroQol Five-Dimensional Questionnaire (EQ-5D-5L) may be the best generic assessment for measuring HRQoL among this patient population.

HRQoL is used to determine a patient’s overall perception of the impact of an illness as well as its treatment. This measurement can be used to support patient-centered care and shared decision-making.²

“Despite the growing recognition of the importance of HRQoL as an outcome measure, further research is needed to determine whether the existing HRQoL instruments effectively reflect and address the most salient issues of this RA patient community,” wrote a team of international investigators.

In the cross-sectional, observational, non-interventional study, conducted at the Department of Rheumatology and Immunology at Qilu Hospital, Shandong University, investigators evaluated HRQoL and the link between clinical activity measures and HRQoL measurements. They also determined the extent to which different aspects of quality of life—such as social, physical, and psychological—were most affected by RA.

A total of 340 patients with RA were invited to participate in a survey designed to assess HRQoL between December 2019 and October 2020. The Stanford Health Assessment Questionnaire Disability Index (HAQ-DI), Assessment of Quality of Life (AQoL)-4D, Short Form 12-item Health Survey (SF-12), and EQ-5D-5L were used to evaluate quality of life. Clinical activity was assessed using the Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR).

Eligible patients met the 2010 RA classification criteria, were aged ≥ 18 years, and had no mental disorders or severe cognitive impairment.

A multivariable linear regression model was employed to compare HRQoL across varying activity levels, while Spearman’s rank correlation coefficient (rs) assessed any link between HRQoL and doctor-reported clinical activity. Patients in clinical remission were used as a reference group.

In total, 314 patients completed the study. The mean age of participants was 52.50 (standard deviation [SD]: 14.73) years, 75% were female, 80% had a high school education or less, and more than half resided in rural areas. Results revealed age, residence, occupation, and annual family income significantly affected disease activity.

Among patients, the mean HAQ-DI score was .87 (SD: .91). Patients in the moderate and high disease activity cohorts reported significantly reduced health state utility values and HRQoL scores compared with the reference cohort (P <.05). Additionally, there was an increase in HAQ-DI scores—indicating more impairment—among these groups (P <.05).

Scores showed a moderate to strong correlation with RA activity (rs = .50—.65). Although all measurements tended to differentiate disease activity, the disease-specific instrument exhibited the highest correlation.

Investigators noted limitations including missing data on body mass index, smoking status, and comorbidities. Additionally, the AQoL-4D was based on Australian preferences; however, previous research has shown using country-specific scoring algorithms does not significantly affect outcomes. As data was collected at a single hospital, results may not be generalizable to the entire Chinese patient population. Lastly, the cross-sectional study design hindered the possibility of making causal inferences about correlations among variables.

Despite these limitations, strengths included using physician-assessed disease activity in combination with patient-reported HRQoL and the use of multiple generic instruments across RA activity.

“Given the strong correlation between clinical activity and HRQoL scores, and the fact that HRQoL serves as an important clinical supplement, incorporating HRQoL assessment into routine clinical evaluations is crucial for patients,” investigators concluded.

References

1. ^{Feng J, Yu L, Fang Y, Zhang X, Li S, Dou L. Correlation between disease activity and patient-reported health-related quality of life in rheumatoid arthritis: a cross-sectional study. BMJ Open. 2024;14(5):e082020. Published 2024 May 2. doi:10.1136/bmjopen-2023-082020}
2. ^{Efficace F , Gaidano G , Lo-Coco F . Patient-reported outcomes in hematology: is it time to focus more on them in clinical trials and hematology practice Blood 2017;130:859–66. doi:10.1182/blood-2017-03-737403}