Abstract
Purpose of Study: Rheumatoid arthritis (RA) is a multisystem disease with various extra-articular manifestations (EAMs). Health-related quality of life (HRQOL) issues are assuming increasing importance in chronic rheumatic diseases like RA. No data on QOL in RA is available from the Indian subcontinent. There is also a paucity of literature on the impact of EAMs on HRQOL in RA. The objective of this study was to address these lacunae. Methods: The study group comprised 81 patients with RA from a rheumatology clinic in India. Quality of life was estimated by the generic HRQOL measure: World Health Organization quality of life instrument (WHOQOL-Bref). Disease activity in RA was measured by calculating Disease Activity Score-28 (DAS28). Results: The mean HRQOL scores of the patients were 12.0±2.8, 13.2±2.7, 14.4±2.9 and 13.3±2.6 in the physical, psychological, social, and environmental domains of the WHOQOL-Bref respectively. Age, gender, disease duration, educational status, constitutional symptoms, rheumatoid factor positivity, erosions and deformities did not influence HRQOL. Disease activity had a negative influence on the physical and psychological domains. Patients with EAMs had significantly higher DAS28 scores compared to patients without EAMs. Even after adjustment for disease activity, patients with EAMs had lower HRQOL scores than patients without these features (statistically significant for physical domain). Conclusions: The physical domain of HRQOL is most affected in Indian patients with RA. Increasing disease activity and presence of EAMs worsens the quality of life.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- ACR:
-
American College of Rheumatology
- DAS28:
-
Disease Activity Score-28
- EAMs:
-
Extra-articular manifestations
- ESR:
-
Erythrocyte sedimentation rate
- GHS:
-
General Health score
- HAQ:
-
health assessment questionnaire
- HRQOL:
-
health-related quality of life
- QOL:
-
quality of life
- RA:
-
rheumatoid arthritis
- RF:
-
rheumatoid factor
- SJC:
-
swollen joint count
- TJS:
-
tender joint count
- VAS:
-
visual analog scale
- WHOQoL-Bref:
-
Brief version of the World Health Organization quality of life instrument, WHOQoL-100
References
WHO Technical Report Series 919. The Burden of Musculoskeletal Conditions at the Start of the New Millennium. WHO Geneva 2003
DP. Lubeck (2002) ArticleTitleHealth-related quality of life measurements and studies in rheumatoid arthritis Am J Manag Care 8 811–820 Occurrence Handle12234022
DA Ruta NP Hurst P Kind M Hunter A. Stubbings (1998) ArticleTitleMeasuring health status in British patients with rheumatoid arthritis: reliability, validity and responsiveness of the Short form 36-item health survey (SF-36) Br Rheumatol 37 425–436 Occurrence Handle10.1093/rheumatology/37.4.425
GJ Tijhuis ZD Jong AH Zwinderman et al. (2001) ArticleTitleThe validity of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire Rheumatology 40 1112–1119 Occurrence Handle10.1093/rheumatology/40.10.1112 Occurrence Handle11600740
P Minnock O Fitzgerald B. Bresnihan (2003) ArticleTitleQuality of life, social support, and knowledge of disease in women with rheumatoid arthritis Arthritis Rheum 49 221–227 Occurrence Handle10.1002/art.11001 Occurrence Handle12687514
R Fitzpatrick S Ziebland C Jenkinson A Mowat A. Mowat (1992) ArticleTitleA generic health status instrument in the assessment of rheumatoid arthritis Br J Rheumatol 31 87–90 Occurrence Handle1737237
JF Fries DR. Ramey (1997) ArticleTitleArthritis specific global health analog scales assess “generic” health related quality-of-life in patients with rheumatoid arthritis J Rheumatol 24 1697–1702 Occurrence Handle9292790
M Borstlap M Laar Particlevan de J Zant J. Korst Particlevan der (1993) ArticleTitleComponents of health: An analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables Ann Rheum Dis 52 650–654 Occurrence Handle8239759
NP Hurst P Kind D Ruta M Hunter A. Stubbings (1997) ArticleTitleMeasuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D) Br J Rheumatol 36 551–559 Occurrence Handle10.1093/rheumatology/36.5.551 Occurrence Handle9189057
T Mikuls K Saag L Criswell L Merlino JR. Cerhan (2003) ArticleTitleHealth related quality of life in women with elderly onset rheumatoid arthritis J Rheumatol 30 952–957 Occurrence Handle12734888
Bartlett SJ, Piedmont R, Bilderback A, Matsumoto AK, Bathon JM. Spirituality, well-being, and quality of life in people with rheumatoid arthritis. Arthritis Rheum 2003 15; 49: 778–783
FC Arnett SM Edworthy DA Block et al. (1988) ArticleTitleThe American Rheumatism Association 1987 revised criteria for the classification of Rheumatoid Arthritis Arthritis Rheum 31 315–324 Occurrence Handle3358796
WHO Technical report series 405. (1968) Nutritional Anaemias. WHO Geneva
DM Vander Heijde MA van’t Hof PL Riel Particlevan et al. (1990) ArticleTitleJudging disease activity in clinical practice in rheumatoid arthritis: First step in the development of a disease activity score Ann Rheum Dis 49 916–920 Occurrence Handle2256738
AM Van Gestel CJ Haagsma PL. Riel Particlevan (1998) ArticleTitleValidation of rheumatoid arthritis improvement criteria that include simplified joint counts Arthritis Rheum 41 1845–1850 Occurrence Handle10.1002/1529-0131(199810)41:10<1845::AID-ART17>3.0.CO;2-K Occurrence Handle9778226
MLL Prevoo MA van’t Hof HH Kuper MA Van Leuween LB Putte Particlevan de PL. Riel Particlevan (1995) ArticleTitleModified Disease Activity Scores that include twenty-eight-joint counts Arthritis Rheum 38 44–48 Occurrence Handle7818570
Fransen J, Stucki G, van Riel PL. Rheumatoid Arthritis Measures. Arthritis Rheum 2003 15; 49: S214–S224
O Steinbrocker CH Traeger RC. Batterman (1949) ArticleTitleTherapeutic criteria in rheumatoid arthritis JAMA 140 659–662
InstitutionalAuthorNameWHOQOL Group. (1995) ArticleTitleThe World Health Organization quality of life assessment (WHOQOL). Position paper from the World Health Organization Soc Sci Med 41 1403–1409
S Saxena K Chandiramani WHOQOL-Hindi. Bhargava R. (1998) ArticleTitleA questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life Natl Med J India 11 160–165 Occurrence Handle9808970
A. Carr (2003) ArticleTitleAdult Measures of Quality of life Arthritis Rheum 49 S113–S133 Occurrence Handle10.1002/art.11414
WJ Taylor J Myers RT Simpson KM McPherson M. Weatherall (2004) ArticleTitleQuality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF): Score distributions and psychometric properties Arthritis Rheum 51 350–357 Occurrence Handle10.1002/art.20398 Occurrence Handle15188318
C Turesson WM O’Fallon CS Crowson SE Gabriel EL. Matteson (2003) ArticleTitleExtra-articular disease manifestations in rheumatoid arthritis: Incidence trends and risk factors over 46 years Ann Rheum Dis 62 722–727 Occurrence Handle10.1136/ard.62.8.722 Occurrence Handle12860726
HM Lapsley LM March KL Tribe MJ Cross BG Courtenay PM. Brooks (2002) ArticleTitleLiving with rheumatoid arthritis: Expenditures, health status, and social impact on patients Ann Rheum Dis 61 818–821 Occurrence Handle10.1136/ard.61.9.818 Occurrence Handle12176807
P Bendtsen J. Hornquist (1992) ArticleTitleChange and status in quality of life in patients with rheumatoid arthritis Qual Life Res 1 296–305 Occurrence Handle10.1007/BF00434943 Occurrence Handle1299461
AL Stewart S Greenfield RD Hays et al. (1989) ArticleTitleFunctional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study JAMA 262 907–913 Occurrence Handle10.1001/jama.262.7.907 Occurrence Handle2754790
MJ Bell C Bombardier P. Tugwell (1990) ArticleTitleMeasurement of functional status, quality of life, and utility in rheumatoid arthritis Arthritis Rheum 33 591–601 Occurrence Handle2183806
KB Hagen LM Smedstad T Uhlig TK. Kvien (1999) ArticleTitleThe responsiveness of health status measures in patients with rheumatoid arthritis: Comparison of disease-specific and generic instruments J Rheumatol 26 1474–1480 Occurrence Handle10405932
TP Suurmeijer M Waltz T Moum et al. (2001) ArticleTitleQuality of life profiles in the first years of rheumatoid arthritis: results from the EURIDISS longitudinal study Arthritis Rheum 45 111–121 Occurrence Handle10.1002/1529-0131(200104)45:2<111::AID-ANR162>3.0.CO;2-E Occurrence Handle11324773
M Borstlap M Laar Particlevan de J Zant J. Korst Particlevan der (1993) ArticleTitleComponents of health: An analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables Ann Rheum Dis 52 650–654 Occurrence Handle8239759
SY Cheah C Clark L Goldberg A LiWan Po RJ. Phillips (1996) ArticleTitleOutcome measures, pooled index and quality of life instruments in rheumatoid arthritis Clin Pharm Ther 21 297–316
Author information
Authors and Affiliations
Corresponding author
Additional information
Address for correspondence: Rohini Handa, Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar 110029, New Delhi, India Phone:
Rights and permissions
About this article
Cite this article
Bedi, G.S., Gupta, N., Handa, R. et al. Quality of Life in Indian Patients with Rheumatoid Arthritis. Qual Life Res 14, 1953–1958 (2005). https://doi.org/10.1007/s11136-005-4540-x
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11136-005-4540-x