The impact of pain on psychological well-being in rheumatoid arthritis: The mediating effects of self-esteem and adjustment to disease

Abstract The aim of this study was to determine whether self-esteem and adjustment to disease can mediate the association between pain and psychological well-being in patients with Rheumatoid Arthritis (RA). Coefficients of correlation, multiple linear regressions and Structural Equation Model (SEM) were employed in order to examine the direct and indirect relationships between pain, self-esteem, adjustment to disease and psychological well-being in a sample of 160 recently-diagnosed RA-patients. The outcomes of the analyses indicate that self-esteem and adjustment to disease are important links between pain and psychological well-being. Moreover, the results suggest the increasing importance of personality variables in mediating the relationship between pain and psychological well-being as the disease advances. The findings provide evidence for considerations that psychosocial interventions, focused on increasing the self-esteem and improving the adjustment to disease, may reduce the impact of pain on patients' psychological well-being and quality of life in general

Is Coping Self-Efficacy Related to Psychological Distress in Early and Established Rheumatoid Arthritis Patients?

The study aimed to explore associations between coping self-efficacy and psychological distress in early and established rheumatoid arthritis (RA) patients. Two samples differing in disease duration were collected at outpatient rheumatology clinics in Eastern Slovakia. The first sample consisted of 146 established patients with disease duration of 12 years or more (age = 58.02 SD = 10.38 years; disease duration = 16.08 SD = 3.60 years; 86 % women) and the second sample consisted of 102 early RA patients with disease duration of 4 years or less (age = 53.25 SD = 12.32; disease duration = 2.8 SD = 1.23 years; 75 % women). The patients underwent a routine rheumatology check and completed questionnaires regarding functional disability, neuroticism and extraversion, coping self-efficacy and psychological distress. The data were analyzed using hierarchical linear regression models. Coping self-efficacy was significantly negatively associated with psychological distress in both samples with the strongest association with anxiety in the early RA group. These associations remained significant after controlling for sociodemographic, disease related and personality variables. Psychological distress was further associated with disease activity, functional disability, neuroticism and extraversion. However, different patterns in respect to anxiety and depression with the duration of RA was observed. Coping self-efficacy accounted for a unique variance in psychological distress even after controlling for the influence of disease activity, functional status and personality traits. The strongest association was observed with anxiety in early RA patients. As a result, management and intervention programs increasing self-efficacy for coping strategies might be beneficial for reducing anxiety and depression especially during the early phase of the disease

Social Support as a Moderator of Functional Disability's Effect on Depressive Feelings in Early Rheumatoid Arthritis:A Four-Year Prospective Study

Objective: To examine associations of depressive feelings with disease-related variables and explore the moderating effect of social support on depressive feelings in individuals with early rheumatoid arthritis (RA) prospectively over 4 years. Method: Data were collected annually over 4 years. The sample consisted of 124 individuals with diagnosed RA (85.5% women; mean age 47.9 years; mean disease duration 22.2 months). The strength of cross-sectional and prospective associations of sociodemographic, disease-related variables and the direct and moderating effects of social support on depression were tested using correlations, multilevel models, and hierarchical linear regressions. Results: The study showed that emotional support moderated the influence of functional disability on depressive feelings in individuals with RA. This was not detected for instrumental support. Further prospective associations between functional status, marital status, and depressive feelings were also found. Overall, the strongest association was found between initial depressive feelings and depressive feelings over time. Conclusions: Initial depression seemed to be a risk factor in explaining later depressive feelings, but emotional support might be prospectively beneficial, especially for individuals with higher levels of disability. Early detection of individuals at risk for depression and providing interventions aimed at the specific functions of social support might help to decrease mental health problems

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Introduction: The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test-retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion: The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables

Social participation in early and established rheumatoid arthritis patients

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients. Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test. Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group. Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA. Implications for Rehabilitation Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life. Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation. Keywords: Anxiety, depression, functional disability, participation, rheumatoid arthriti

The Roma Population Living in Segregated Settlements in Eastern Slovakia Has a Higher Prevalence of Metabolic Syndrome, Kidney Disease, Viral Hepatitis B and E, and Some Parasitic Diseases Compared to the Majority Population

Background: The Roma population is one of the largest marginalized population groups in Europe. The aim of our work was to summarize the morbidity of lifestyle-related diseases and infectious diseases in the Roma population living in segregated settlements. Methods: We used data from the cross-sectional study HepaMeta, in which we examined 452 Roma subjects with an average age of 34.7 ± 9.1 years, 35.2% of which were men, and 403 non-Roma subjects with an average age of 33.5 ± 7.4 years, 45.9% of which were men. We collected data by means of a questionnaire, anthropometric measures, and we analyzed blood and urine samples. Results: Roma subjects had a higher incidence of metabolic syndrome (RR: 1.478 (1.159–1.885), p < 0.0001), obesity or waist circumference >94 cm in men/80 cm in women (RR: 1.287 (1.127–1.470), p < 0.0001), and HDL-C < 1.03 mmol/L in men or <1.29 in women (RR: 2.004 (1.730–2.321), p < 0.0001) than their non-Roma counterparts. Subjects of the Roma population were more frequently diagnosed with kidney disease (RR: 1.216 (1.096–1.349), p < 0.0001), HBsAg positivity (RR: 4.468 (2.373–8.415), p < 0.0001), anti HBc IgG positivity (RR: 3.13 (2.598–4.224), p < 0.0001), and anti HEV positivity (RR: 2.972 (1.226–7.287), p < 0.0001). Serological markers of Toxoplasma gondii infection and Toxocara spp. were observed much more frequently among Roma than non-Roma subjects (RR: 1.868 (1.520–2.296), p < 0.0001, for Toxoplasma gondii; and RR: 21.812 (8.097–58.761), p < 0.0001, for Toxocara spp.). Conclusions: Poor socio-economic conditions, an unhealthy lifestyle, and barriers precluding access to healthcare are factors that affect the Roma population in settlements and lead to an increased prevalence of metabolic syndrome and its components, kidney disease, viral hepatitis B and E, and some parasitic diseases

Social Participation and Health Related Quality of Life in Early and Established Rheumatoid Arthritis Patients

Social participation has been recognized as one of the key variables to be addressed in disability research yet few studies addressed the association between restriction in participation and quality of life in the context of rheumatoid arthritis. The aim of this study was to explore the associations between restrictions in social participation and health related quality of life (HRQoL) in early and established group of rheumatoid arthritis (RA) patients. Two samples with early (n = 97; age = 53 +/- 12.3 years; disease duration = 2.8 +/- 1.2 years; 76 % women) and established (n = 143; age = 58 +/- 10.3 years; disease duration = 16.1 +/- 3.6 years; 86 % women) RA patients were collected. Respondents completed questionnaires on pain (NHP), fatigue (VAS), functional disability (HAQ), depression (HADS), social participation restrictions (Participation scale) and health related quality of life (SF-36). Data were analyzed using stepwise regression models controlling for the relevant variables. Perceived social participation restrictions in the group of early patients were found to be negatively associated with the mental health component of the HRQoL (beta = -0.192; p a parts per thousand currency sign 0.05) and in the established RA group with the physical health component of the HRQoL (beta = -0.271; p a parts per thousand currency sign 0.001). These results generally suggest the importance of social participation with regard to HRQoL in RA

Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

Published by Elsevier Ltd.Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities.MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).info:eu-repo/semantics/publishedVersio