Physical, psychosocial and economic impact of rheumatoid arthritis: a pilot study of patients seen at a tertiary care referral centre.

ABSTRACT

BACKGROUND: Rheumatoid arthritis is associated with marked physical disability. In addition, it has an impact on patients' psyche and social well-being, and entails a major financial burden. The impact of the disease in different cultural and social backgrounds is varied. Limited data are available from India on this aspect. METHODS: Patients with rheumatoid arthritis satisfying the 1987 modified American College of Rheumatology criteria were included. Besides demographic data, functional impact was assessed using the Health Assessment Questionnaire (HAQ). The psychosocial impact was measured using the medical outcomes study short form 36 (SF-36) with minor modifications. Data on direct and indirect health costs were collected by direct interview. RESULTS: The mean age of 101 patients (90 women) was 43.2 years and mean duration of disease was 8 years. Their mean (SD) HAQ score was 0.97 (0.69) with 8 patients having scores > 2. On the SF-36 scale (0-100) the mean (SD) score for various domains were physical functioning 49.90 (28.55), social functioning 55.51 (20.59), role limitation due to physical problems 32.67 (41.34), role limitation due to emotional problems 47.54 (40.08), mental health 47.36 (7.99), general health perception 52.38 (8.30), energy and vitality 58.56 (6.09), and bodily pain 49.26 (18.87). The summary score for the physical component was 37.95 (9.03) and for the mental component it was 47.71 (4.81). While the physical component summary score had excellent negative correlation with the HAQ score (r = -0.84), correlation with the mental component summary score was poor (r = 0.32). The annual average total cost burden per patient was Rs 16 758, of which Rs 11 617 (67%) was spent on health services and the rest on non-health services (travel, home help and loss of wages). CONCLUSION: Rheumatoid arthritis causes significant physical and social disability besides being an economic burden. Indian patients had good scores for mental and social health suggesting good family support systems or reluctance to express their feelings despite physical disability.