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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1086-1093. doi: 10.19723/j.issn.1671-167X.2022.06.005

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Cross-sectional study on quality of life and disease activity of rheumatoid arthritis patients

Jing-feng ZHANG,Yin-ji JIN,Hui WEI,Zhong-qiang YAO,Jin-xia ZHAO*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-08-10 Online:2022-12-18 Published:2022-12-19
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com

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Abstract:

Objective: To analyze health related quality of life (HR-QoL) and physical function of outpatient department patients with rheumatoid arthritis (RA), and to analyze disease activity influence in HR-QoL and functional capacity as well as the divergences between different disease activity standards. Methods: The demographic and clinical data of 207 RA cases from Department of Rheumatology and Immunology, Peking University Third Hospital from Jan 2021 to Jul 2021 were collected. RA-specific quality of life (RA-QoL) and the medical outcome 36-item short form health survey (SF-36)were collected to estimate the quality of life. The t test was used for the quantitative data in accordance with normal distribution. Results: A total of 207 cases were included, with RA-QoL score of 7.8±7.1, physical component summary (PCS) score of 63.8±23.8, and mental component summary (MCS) score of 71.7±21.0. According to disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR), there were 119 patients (59.5%) with remission and low disease activity, and 125 patients (62.5%) with simplified disease activity index (SDAI). The HR-QoL of the patients with remission or low disease activity was significantly better than that of the patients with moderate or high disease activity. The physical function (76.7±17.2 vs. 86.4±15.0, t=2.855, P < 0.01), bodily pain (67.8±8.5 vs. 77.7±15.6, t=4.277, P < 0.01) and health transition (52.8±22.3 vs. 63.9±24.1, t=2.134, P < 0.05) in the low disease activity (LDA) group were lower than those in the complete remission (REM) group according to DAS28-ESR. Other domains of SF-36 and RA-QoL had no differences between these two groups. PCS in the LDA group was lower than that in the REM group (68.3±15.2 vs. 77.3±15.2, t=2.716, P < 0.01), but MCS was not different between the two groups. Determined by SDAI, the RA-QoL score in the LDA group was significantly higher than that in the REM group (9.4±7.1 vs. 6.0±4.8, t=-2.260, P < 0.05), the various dimensions of physical function in the SF-36 score and the PCS score (69.9±16.4 vs. 81.4±15.1, t=3.879, P < 0.05) were lower than that in the REM group, and the MCS score was lower than that in the REM group (67.9±19.3 vs. 74.5±18.8, t=2.721, P < 0.01). Conclusion: The RA-QoL and SF-36 scores of RA patients in outpatient clinics were better, and the MCS was higher than the PCS. Treat-to-target is essential to improve HR-QoL. SDAI can better indicate the HR-QoL of each domain in REM and LDA RA patients.

Key words: Rheumatoid arthritis, Quality of life, Disease activity score, SF-36

CLC Number: 

  • R593.22

Table 1

Demographic and clinical characteristics of RA patient"

Items Patients (n=207)
Age/years 52.3±15.6
Age at diagnosis/years 44.1±16.1
Female 80.2%
Disease duration/years 6 (8)
Antibodies
  RF+ anti-CCP+ 49.0%
  RF+ anti-CCP- 17.5%
  RF- anti-CCP+ 19.0%
  RF- anti-CCP- 14.5%
Anemia 22.5%
Thrombocytosis 10.0%
Hyperglobulinemia 23.7%
Decreased 25(OH)VD3 63.8%
Positive ANA 30.7%
TJC 1 (4)
SJC 0 (3)
ESR/(mm/h) 13.0 (14.8)
CRP/(mg/L) 3.8 (8.0)
Treated with biologics 11.2%
Treated with 1 cDMARD 18.9%
Treated with 2 cDMARDs 42.2%
Treated with 3 cDMARDs 18.4%
Treated with tDMARDs 9.2%

Table 2

Disease activity of RA patient  n(%)"

Items DAS28-ESR DAS28-CRP CDAI SDAI
REM 92 (46.0) 106 (53.0) 43 (21.5) 46 (23.0)
LDA 27 (13.5) 22 (11.0) 83 (41.5) 79 (39.5)
MDA 51 (25.5) 51 (25.5) 43 (21.5) 49 (24.5)
HDA 30 (15.0) 21 (10.5) 31 (15.5) 26 (13.0)

Table 3

Correlation coefficients between clinical variables and patient-reported outcomes of RA patient"

Items DAS28-ESR SDAI Age Duration of disease TJC SJC ESR CRP
G-VAS r= 0.736** r=0.744** r=0.290** r=0.081 r=0.586** r=0.545** r=0.511** r=0.391**
P-VAS r=0.742** r=0.734** r=0.230** r=-0.003 r=0.599** r=0.586** r=0.482** r=0.356**
RA-QoL r=0.637** r=0.617** r=0.306** r=0.125 r=0.524** r=0.552** r=0.482** r=0.342**
SF-36
  PF r=-0.663** r=-0.643** r=-0.453** r=-0.025 r=-0.522** r=-0.526** r=-0.562** r=-0.461**
  RP r=-0.574** r=-0.537** r=-0.241** r=0.016 r=-0.477** r=-0.467** r=-0.398** r=-0.324**
  BP r=-0.718** r=-0.689** r=-0.299** r=-0.018 r=-0.573** r=-0.579** r=-0.542** r=-0.402**
  GH r=-0.501** r=-0.450** r=-0.248** r=-0.077 r=-0.347** r=-0.322** r=-0.346** r=-0.284**
  VT r=-0.448** r=-0.454** r=-0.255** r=0.002 r=-0.349** r=-0.328** r=-0.385** r=-0.303**
  SF r=-0.514** r=-0.488** r=-0.307** r=0.013 r=-0.403** r=-0.373** r=-0.438** r=-0.312**
  RE r=-0.371** r=-0.360** r=-0.152* r=0.117 r=-0.317** r=-0.321** r=-0.296** r=-0.151*
  MH r=-0.361** r=-0.372** r=-0.140* r=0.020 r=-0.273** r=-0.291** r=-0.339** r=-0.260**
HT r=-0.532** r=-0.482** r=-0.216** r=0.004 r=-0.435** r=-0.404** r=-0.390** r=-0.252**
PCS r=-0.710** r=-0.668** r=-0.349** r=-0.021 r=-0.561** r=-0.553** r=-0.527** r=-0.421**
MCS r=-0.492** r=-0.484** r=-0.243** r=0.064 r=-0.396** r=-0.389** r=-0.417** r=-0.279**

Table 4

Patient-reported outcomes in different disease activity (determined by DAS28-ESR)"

Table 5

Patient-reported outcomes in different disease activity (determined by SDAI)"

Figure 1

Comparison of SF-36 among levels of disease activity determined by DAS28-ESR DAS-28, disease activity score 28; ESR, erythrocyte sedimentation rate; SF-36, the medical outcome 36-item short form health survey; PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social function; RE, role emotional; MH, mental health; REM, remission; LDA, low disease activity; MDA, moderate disease activity; HDA, high disease activity."

Figure 2

Comparison of SF-36 among levels of disease activity determined by SDAI SDAI, simplified disease activity index; other abbreviations as in Figure 1."

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