Psychosocial factors are predictor of early rheumatoid arthritis functional disability, suggests study
According to a new study published in Arthritis & Rheumatology, psychosocial factors such as anxiety, depression and work absenteeism are more predictive than traditional clinical factors of 1-year functional disability in patients with early rheumatoid arthritis or undifferentiated inflammatory arthritis.
Dr Caroline Kronisch and a team of researchers at the University of Aberdeen analysed data from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort, and found that independent predictors of functional disability at one year included depression, anxiety and work disability.
Dr Kronisch says the study is good, but lacks sensitivity, but she points out that she and her team were the first to identify the predictive importance of work absenteeism and excessive weight on functional disability in rheumatoid arthritis and undifferentiated inflammatory arthritis and that, “Early identification of these problems by the rheumatology team and subsequent channelling towards other relevant health services is considered idea practice, but does not commonly occur due to limited resource.”
The SERA inception cohort is a prospective multicentre study of newly presenting patients with rheumatoid arthritis and undifferentiated inflammatory arthritis. The researchers analysed SERA data to determine baseline predictors of disability, defined as a health Assessment Questionnaire (HAQ) score of 1 or higher, at 1 year.
The study involved 578 patients who had completed one year of follow-up, with a median age of 60.5 years and 64.5% were female. Most participants were being treated with methotrexate monotherapy and the remainder with either sulfasalazine, hydroxychloroquine, leflunomide, or a standard combination of disease-modifying anti-rheumatic drugs. None of the participants was receiving a biological therapy.
Of the 578 participants in the study, 60.7% reported functional disability at baseline which declined to 36.7% at one year. These were independently predicted by baseline disability, depression, anxiety, in paid employment with absenteeism during the last week, not in paid employment and being overweight.
“The rheumatoid arthritis landscape has been transformed by changes in therapeutic approach and so we have sought to re-evaluate the baseline predictors of 1 year disability within a generalisable and contemporary national rheumatoid arthritis cohort,” say the researchers.
“Psychosocial rather than traditionally clinical prognostic factors have been identified to be important in this new era. The identified predictors are potentially modifiable by common non-pharmacological approaches underpinned by educational, exercise and behavioral interventions. Those at greatest risk of disability may benefit from such preventative strategies.”
Although the authors admit to not collecting all possible predictors in their study, such as chronic pain, they say that their results do “highlight the importance of holistic patient evaluations” and that the observation that poor mental health status is a better predictor of functional disability than disease activity, could reflect the success of modern drugs for targeting disease activity. “Thus, high presenting levels of disease activity are promptly and effectively addressed leading to a weaker association with functional disability later in the course of disease. In contrast, psychosocial issues remain inadequately targeted in standard care.”
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