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Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Influencing Factors in Tunisian Rheumatoid Arthritis Patients’ Quality of Life: Burden and Solutions

Author(s): Soumaya Boussaid*, Sarra Jeriri, Sonia Rekik, Emna Hannech, Samia Jammali, Elhem Cheour, Hela Sahli and Mohamed Elleuch

Volume 19, Issue 3, 2023

Published on: 27 December, 2022

Page: [314 - 320] Pages: 7

DOI: 10.2174/1573397119666221118143624

Price: $65


Background: Rheumatoid Arthritis (RA) is a disease with a heavy functional, psychological, and socioeconomic impact. The management of Quality of Life (QoL) as a therapeutic objective is a fairly recent notion, especially in Tunisia. We aimed to evaluate QoL in RA patients and to identify its affecting factors.

Methods: This was a cross-sectional study in a Tunisian rheumatology center. To assess QoL, we used the Short Form Health Survey (SF-36) and the Arthritis Impact Measurement Scales Short Form (AIMS2-SF). Health Assessment Questionnaire Disability Index (HAQ), the Hospital Anxiety and Depression Scale (HAD) for psychological disorders, Visual Analog Scale for Pain (VAS Pain), and for fatigue (VAS Fatigue) were also used. Disease activity was assessed by the Disease Activity Score (DAS28 CRP).

Results: We enrolled 120 established RA, the mean age of our patients was 56.9 ± 11.4 years, with a predominance of women (83.3%). The mean disease duration was 10.97 ± 7.7 years. According to the HAD scale, 27% of our patients presented anxiety, and 26.7% had depressive disorders. There was significantly impaired QoL in patients with low educational level, dependent financial situation, long disease duration, high disease activity, high pain and fatigue levels, poor therapeutic education, functional disability, and psychological disorders (p < 0.001). A strong negative correlation was detected between inflammatory markers, structural damage, and the scores of QoL. Patients under biologics scored significantly higher in the SF36 mental health domain (p < 0.001).

Conclusion: QoL is significantly poor in Tunisian RA. These patients should be managed using a multidisciplinary approach involving the patients themselves.

Keywords: Rheumatoid arthritis, quality of life, depression, anxiety, fatigue, mental health.

Graphical Abstract
Combe B, Lukas C, Morel J. Rheumatoid arthritis in adults: Epidemiology, clinic and diagnosis. In: Encycl Med Chir Elsevier Masson, Paris, EMC musculoskeletal system. 2015; p. 16.
Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis. JAMA 2018; 320(13): 1360-72.
[] [PMID: 30285183]
Machin AR, Babatunde O, Haththotuwa R, et al. The association between anxiety and disease activity and quality of life in rheumatoid arthritis: A systematic review and meta-analysis. Clin Rheumatol 2020; 39(5): 1471-82.
[] [PMID: 31897960]
World health organization Quality of Life Group. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res 1993; 2(2): 153-9.
[] [PMID: 8518769]
Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014; 73(3): 492-509.
[] [PMID: 24161836]
Haroon N, Aggarwal A, Lawrence A, Agarwal V, Misra R. Impact of rheumatoid arthritis on quality of life. Mod Rheumatol 2007; 17(4): 290-5.
[] [PMID: 17694261]
Intriago M, Maldonado G, Cardenas J, Rios C. Quality of life in Ecuadorian patients with established rheumatoid arthritis. Open Access Rheumatol 2019; 11: 199-205.
[] [PMID: 31565005]
Bejarano V, Quinn M, Conaghan PG, et al. Effect of the early use of the anti-tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis. Arthritis Rheum 2008; 59(10): 1467-74.
[] [PMID: 18821658]
Furuya H, Kasama T, Isozaki T, et al. Effect of TNF antagonists on the productivity of daily work of patients with rheumatoid arthritis. J Multidiscip Healthc 2013; 6: 25-30.
[PMID: 23355786]
Lahiri M, Cheung PPM, Dhanasekaran P, et al. Evaluation of a multidisciplinary care model to improve quality of life in rheumatoid arthritis: A randomised controlled trial. Qual Life Res 2021; 31(6): 1749-59.
[] [PMID: 34741249]
Guermazi M, Allouch C, Yahia M, et al. Translation in Arabic, adaptation and validation of the SF-36 health survey for use in Tunisia. Ann Phys Rehabil Med 2012; 55(6): 388-403.
[] [PMID: 22795246]
Pouchot J, Guillemin F, Coste J, Brégeon C, Sany J. Validity, reliability, and sensitivity to change of a French version of the arthritis impact measurement scales 2 (AIMS2) in patients with rheumatoid arthritis treated with methotrexate. J Rheumatol 1996; 23(1): 52-60.
[PMID: 8838508]
Goussault C, Coiffier G, Albert JD, et al. Assessment of the quality of life of a sample of 119 patients with rheumatoid arthritis using the French version of the health assessment questionnaire(II). 2016; 83: A206.
Terkawi A, Tsang S, AlKahtani G, et al. Development and validation of Arabic version of the hospital anxiety and depression scale. Saudi J Anaesth 2017; 11(5) (Suppl. 1): 11.
[] [PMID: 28616000]
Matcham F, Scott IC, Rayner L, et al. The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44(2): 123-30.
[] [PMID: 24973898]
Martinec R, Pinjatela R, Balen D. Quality of life in patients with rheumatoid arthritis - a preliminary study. Acta Clin Croat 2019; 58(1): 157-66.
[] [PMID: 31363338]
Uhlig T, Kvien TK, Glennås A, Smedstad LM, Førre O. The incidence and severity of rheumatoid arthritis, results from a county register in Oslo, Norway. J Rheumatol 1998; 25(6): 1078-84.
[PMID: 9632067]
Al-Jabi SW, Seleit DI, Badran A, Koni A, Zyoud SH. Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: A cross-sectional study from Palestine. Health Qual Life Outcomes 2021; 19(1): 241.
[] [PMID: 34645455]
Wu Y, Zheng H, Liu Z, et al. Depression and anxiety-free life expectancy by sex and urban-rural areas in jiangxi, china in 2013 and 2018. Int J Environ Res Public Health 2021; 18(4): 1991.
[] [PMID: 33670818]
Khan A, Pooja V, Chaudhury S, Bhatt V, Saldanha D. Assessment of Depression, Anxiety, Stress, and quality of life in rheumatoid arthritis patients and comparison with healthy individuals. Ind Psychiatry J 2021; 30 (Suppl. 1): S195-200.
[PMID: 34908689]
Tsuji H, Yano K, Furu M, et al. Time-averaged disease activity fits better joint destruction in rheumatoid arthritis. Sci Rep 2017; 7(1): 5856.
[] [PMID: 28724913]
Darvish N, Hadi N, Aflaki E, Salehi Rad K, Montazeri A. Health- related quality of life in patients with systemic lupus erythematosus and rheumatoid arthritis compared to the healthy population in Shiraz, Iran. Shiraz E Med J 2017; 18(3): e39075.
Ruta D, Hurst NP, Kind P, Hunter M, Stubbings A. Measuring health status in British patients with rheumatoid arthritis: Reliability, validity and responsiveness of the short form 36-item health survey (SF-36). Br J Rheumatol 1998; 37(4): 425-36.
[] [PMID: 9619895]
Soubrier M, Dougados M. What criteria should the rheumatologist know and use to monitor rheumatoid arthritis? J Rheum 2005; 723: 207-12.
Bucourt E, Martaillé V, Goupille P, et al. A comparative study of fibromyalgia, rheumatoid arthritis, spondyloarthritis, and Sjögren’s Syndrome; Impact of the disease on quality of life, psychological adjustment, and use of coping strategies. Pain Med 2021; 22(2): 372-81.
[] [PMID: 31710690]
Ko KM, Moon SJ, Koh JH, Pae CU, Min JK. Contribution of personality traits, psychological factors, and health-related quality of life to medication adherence in patients with rheumatoid arthritis. Yonsei Med J 2020; 61(5): 406-15.
[] [PMID: 32390364]
Coenen M, Cieza A, Stamm TA, Amann E, Kollerits B, Stucki G. Validation of the international classification of functioning, disability and health (ICF) core set for rheumatoid arthritis from the patient perspective using focus groups. Arthritis Res Ther 2006; 8(4): R84.
[] [PMID: 16684371]
Nikiphorou E, Norton SJ, Carpenter L, et al. Remission vs low disease activity: function, quality of life and structural outcomes in the early rheumatoid arthritis study and network. Rheumatology (Oxford) 2020; 59(6): 1272-80.
[] [PMID: 31580448]
Neuberger GB, Press AN, Lindsley HB, et al. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Res Nurs Health 1997; 20(3): 195-204.
[<195:AID-NUR3>3.0.CO;2-D] [PMID: 9179174]
Choy EH, Dures E. Fatigue in rheumatoid arthritis. Rheumatology (Oxford) 2019; 58 (Suppl. 5): v1-2.
[] [PMID: 31682273]
Chen MH, Lee MH, Liao HT, Chen WS, Lai CC, Tsai CY. Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment. Clin Rheumatol 2018; 37(2): 429-38.
[] [PMID: 29307092]
Wysocka-Skurska I, Sierakowska M, Kułak W. Evaluation of quality of life in chronic, progressing rheumatic diseases based on the example of osteoarthritis and rheumatoid arthritis. Clin Interv Aging 2016; 11: 1741-50.
[] [PMID: 27932870]
Gudelj Gračanin A, Matić A, Mikula T, et al. Influence of biological therapeutics on patient-reported quality-of-life outcomes (whoqol-bref), functional scores and disease activity among croatian patients with rheumatoid arthritis: Our experience. Psychiatr Danub 2020; 32 (Suppl. 4): 547-52.
[PMID: 33212462]
Strand V, Singh JA. Improved health-related quality of life with effective disease-modifying antirheumatic drugs: Evidence from randomized controlled trials. Am J Manag Care 2007; 13 (Suppl. 9): S237-51.
[PMID: 18095787]
Contreras-Yáñez I, Cabiedes J, Rull-Gabayet M, Pascual-Ramos V, Ponce De León S. Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Med Sci 2010; 340(4): 282-90.
[] [PMID: 20881757]
Sokka T, Häkkinen A, Krishnan E, Hannonen P. Similar prediction of mortality by the health assessment questionnaire in patients with rheumatoid arthritis and the general population. Ann Rheum Dis 2004; 63(5): 494-7.
[] [PMID: 15082478]
Hendi R. Long-term evaluation of an educational approach for patients with rheumatoid arthritis [thesis] Rheumatology 2015; 130.
Beauvais C, Prier A, Berenbaum F, Molcard S, Le Gars L, Karneff A, et al. Multidisciplinary treatment of rheumatoid polyarthritis: prospective study of 4 years. Rhumatologie 1998; 50(7): 203-33.
Wang J, Yang Z, Zheng Y, et al. Effects of illness perceptions on health-related quality of life in patients with rheumatoid arthritis in China. Health Qual Life Outcomes 2021; 19(1): 126.
[] [PMID: 33879176]

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