An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis

Objective: To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA).

Methods: A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI.

Results: Lower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes.

Conclusions: The findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.