| ObjectivesRheumatoid arthritis(RA)is an autoimmune disease characterized by symmetric polyarticular lesions and is one of the most common rheumatic diseases.RA is not yet curable,and clinical manifestations are characterized by joint swelling,pain,limited function,also including extra-articular manifestations such as fever,subcutaneous nodules,and lesion of liver,kidney or other organs.The progression of RA may eventually lead to joint deformity,with high morbidity and teratogenicity,which seriously affect the quality of life.The quality of life is an important indicator to evaluate the physiological,psychological and social functions of rheumatic patients.The illness perception is an individual’s cognitive and emotional representations of the illness,that is,the personal view of the disease.Studies have shown that illness perception can affect the quality of life,social function of patients,and the prognosis of the disease.The studies of illness perceptions in rheumatism were more extensive abroad,but studies on illness perceptions of RA patients have not been reported in China.Therefore,this study aims to explore the levels of illness perceptions and quality of life in patients with RA in China,and further analyze the influencing factors of illness perception,quality of life and their correlations.Our study can provide reference for improving the illness perception level,prognosis,and quality of life in RA.Further,this study can better guide clinicians in management of RA,and formulate reasonable,feasible,targeted and individualized treatment plans.Thus,this study has great practical significance.MethodsBy random sampling method,from March to December in 2017,200 RA patients diagnosed in the Department of Rheumatology at a tertiary-level hospital in Xi’an were selected.Using the Chinese version of the Brief Illness Perception Questionnaire(BIPQ)and the MOS 36-Item Short-Form Health Survey(SF-36),and General demographic questionnaire to assess the illness perceptions and quality of life.The survey was conducted by face-to-face interviews.Before the formal investigation,the investigators first introduced the purpose of the survey,filled out the methods,and signed informed consent.For patients who have difficulty in writing,they can be filled in by an investigator or family member.The database was established by Epi Data and analyzed by SPSS 18.0.The data were presented as x ±s,number and percentage.Independent-Samples t-test and one-way ANOVA were used to analyze the inter-group difference.Multivariate stepwise regression analysis was used to study the influential factors of illness perception and quality of life.Multiple stepwise regression and structural equation models were used to explore the correlation between illness perception and quality of life after controlling family demography and disease characteristics.Results1.General characteristics 191 validated questionnaires were got back from 200 questionnaires,with an answering rate of 95.5%.Among them,51 were males and 140 were females.The average age of the subjects is 45.06±13.32,46.6% of patients under the age of 45,53.4% of patients over the age of 45.42.93% of the students were in the junior high school and below,50.26% of patients lived in the city,49.21% of patients whose monthly household income per capita is between 1,000 to 3,000 yuan,39.79% of patients engaged in mental work,37.7% of patients had a course of more than 5 years,26.18% of patients were in remission,and 16.75% of patients had severe disease.2.Illness perceptions in patients with RA The total BIPQ score in patients with RA was 49.09±11.06.The scores of each dimension of BIPQ were arranged as followed: BIPQ-6(illness concern)9.15±1.81,BIPQ-2(timeline)7.68±2.78,BIPQ-4(treatment control)7.83±2.31,BIPQ-8(emotions)7.15±2.97,BIPQ-1(consequences)6.72±3.02,BIPQ-5(identity)6.61±2.74,BIPQ-7(comprehensibility)6.08±2.60,BIPQ-3(personal control)4.30±2.52.There were significant differences in the scores of BIPQ among different ages,marital status,education levels,residence types,family monthly incomes,occupation types,courses of disease and DAS28 scores(P<0.05),but not genders and nationalities(P>0.05).Patients over 45 years of age,BIPQ-1(consequences),BIPQ-5(identity),and BIPQ total score were higher than those under 45 years of age(P < 0.05).In patients who were in junior middle school and the following education level,lived in the villages and towns,the family monthly income less than 1,000 yuan,unemployed(including retirement)or engaged in physical labor,longer course of disease,and higher DAS28 scores,the scores of BIPQ-1(consequences),BIPQ-5(identity)and BIPQ total scores were increased.Patients with a family average monthly income of more than 3,000 yuan have the highest score for BIPQ-3(personal control).In addition,patients with longer courses of the disease and the higher DAS28 scores,had a higher scores in BIPQ-1(consequences),BIPQ-2(timeline),BIPQ-5(identity),BIPQ-7(comprehensibility),BIPQ-8(Emotions),BIPQ total scores.Multivariate analysis showed that genders,education levels,types of residence,family monthly incomes,course of disease and DAS28 scores were the influential factors of illness perception in patients with RA(P<0.05).Among them,residence(county,city),educational level(college or above),DAS28 scores were related to BIPQ-1(consequences)(P<0.05);Patients who lived in the county or city,or with college or above education level,all believed that the disease had less consequences on them.Patients with higher DAS28 scores believed the disease had greater impact on them;Courses of disease and DAS28 scores were related to BIPQ-2(timeline)(P<0.05).The longer the course of the disease,the higher the DAS28 scores,the more patients think that RA is a long-term chronic disease.Family monthly income(1,000~3,000 yuan,over 3,000 yuan),DAS28 scores were related to BIPQ-3(personal control)(P<0.05),patients with the higher family monthly incomes feel better about disease control;Patients with the higher DAS28 scores felled less control over the disease.Genders was related to BIPQ-4(treatment control)(P<0.05).Family monthly income(1,000~3,000 yuan,over 3,000 yuan),courses of disease,DAS28 scores were related to BIPQ-5(identity)(P<0.05),patients with the more family monthly income experienced little symptoms of disease;Patients with the longer courses of disease and more serious disease activity experienced more symptoms of disease;DAS28 scores were related to BIPQ-6(illness concern)and BIPQ-8(Emotions)(P<0.05),patients with more serious disease activity paid more attention to disease and more bad emotional response.Educational level(technique school/high school)and(college or above),the courses of disease were related to BIPQ-7(comprehensibility)(P<0.05),patients with higher educational level and the longer courses of disease known more about disease.Family monthly income(1,000~3,000yuan)and(over 3,000 yuan),DAS28 scores were related to BIPQ total scores(P<0.05),patients with better economic conditions had more positive illness perceptions;patients with more serious disease activity had more negative illness perceptions.3.The quality of life in patients with RA In our study,eight dimensions of quality of life in patients with RA were compared,three dimensions had a higher scores,including,social functioning 74.93±32.05,physiological function 58.53±29.44,mental health 60.86±22.81.Additionally,two dimensions had lower scores: role physical 22.25±36.67,general heath 36.71±20.44.There were significant differences in the scores of QOL among different ages,nationalities,marital status,education levels,occupation types,residence types,family monthly incomes,courses of disease and DAS28 scores(P<0.05),but genders had no significant differences(P>0.05).Patients over 45 years of age,physiological function,vitality,social functioning was lower than those under 45 years of age(P<0.05),the quality of life of them were poor.Patients with higher education level had the better quality of life,and patients who engaged in mental job had better quality of life than the manual workers(including unemployed).Patients lived in city had better quality of life than lived in the county or village;Patients with family monthly income of more than 3,000 yuan had the best quality of life.Patients in courses of disease over 5 years had the worst quality of life;There were significant differences in the scores of QOL among different DAS28 scores(P<0.05),patients with more serious disease activity had much worse quality of life.Multivariate analysis showed that ages,education levels,courses of disease and DAS28 scores were the influential factors of quality of life in patients with RA(P<0.05).Among them,ages,education levels(technique school or high school),courses of disease and DAS28 scores were related to physiological function(P<0.05),the older of the patients the worse the physiological function is.The level of physical activity of patients with education levels(technique school or high school)is higher than those with low level of education.patients in longer courses of disease and with more serious disease activity had much worse physiological function.DAS28 scores were related to role physical,general heath and role motional(P<0.05),the higher the DAS28 scores,the lower the quality of life,the patients are prone to a series of bad emotions such as anxiety and depression.Ages,educational level(technique school or high school)and(college or above),DAS28 scores were related to bodily pains(P<0.05),the patients with more higher education levels,had better quality of life than those with low levels education levels.Patients with the higher DAS28 scores had the worse quality of life.Educational levels(technique school or high school)and DAS28 scores were related to vitality,social functioning and mental health(P<0.05),patients with higher education level were not very tired,and the social activities,work,life and mental health were not greatly affected;the patients with higher DAS28 score increased their fatigue sense,the psychological burden increased,and the patient’s quality of life was worse.4.The correlation between illness perceptions and quality of life in RA patients The results of Pearson correlation analysis showed that the negative correlation of BIPQ-1(consequences)and 8 dimensions of quality of life(r=-0.47,-0.32,-0.50,-0.43,-0.48,-0.45,-0.38 and-0.33,respectively,P<0.05);The negative correlation of BIPQ-5(identity)and 8 dimensions of quality of life(r=-0.51,-0.42,-0.55,-0.42,-0.47,-0.50,-0.36 and-0.30,respectively,P<0.05);The negative correlation of BIPQ-8(Emotions)and 8 dimensions of quality of life(r =-0.48,-0.40,-0.53,-0.50,-0.52,-0.53,-0.52and-0.35,respectively,P<0.05);The negative correlation of the overall BIPQ scores and 8 dimensions of quality of life(r =-0.59,-0.45,-0.62,-0.58,-0.58,-0.60,-0.46and-0.48,respectively,P<0.05);The positive correlation of BIPQ-3(personal control)and 8 dimensions of quality of life(r = 0.336,0.175,0.299,0.377,0.320,0.322,0.196 and 0.429,respectively,P<0.05);There is a certain correlation between the other items of BIPQ and the quality of life(P<0.05).Multivariate analysis showed that illness perceptions were related to quality of life when the demographic factors and disease characteristics were controlled(P<0.05).BIPQ-2(timeline),BIPQ-6(illness concern)and the overall BIPQ score were related to physiological function(P<0.05),the longer courses of disease,the more concerned about the disease,the poorer the overall cognition of the disease and the worse the physiological function of the patient.The overall BIPQ score were related to vitality(P<0.05),The poorer the overall levels of cognition,the more limited the physical function of the patient,the more obvious the somatic pain,and the stronger the fatigue.BIPQ-7(compre-hensibility)and the overall BIPQ score were related to general heath(P<0.05,the poorer the overall levels of disease cognition,the worse the general health of the patients.BIPQ-6(illness concern)and the overall BIPQ score were related to social functioning P<0.05),the higher the patient’s attention to the disease,the better the overall cognitive levels of the disease,the better the social function of the patient.BIPQ-1(consequence)and the overall BIPQ score were related to role motional(P<0.05),the more serious the disease had on the patient,the worse the overall levels of the patient’s cognition was,the more serious the emotional problem was.BIPQ-7(comprehensibility)and BIPQ-8(emotions)were related to mental health(P<0.05),the better the patient’s understanding of the disease was,the better the mental health was.BIPQ-3(personal control),BIPQ-4(treatment control)and BIPQ-5(identity)were not related to 8 dimensions of quality of life(P>0.05).The results of structural equation modeling indicated that the revised theoretical model of the relationship between illness perceptions and quality of life was consistent with the actual data,and the fitting degree is better,and the matching index is better.Illness perceptions were highly correlated with quality of life,with a correlation coefficient of-0.85.Conclusion1.The scores of each dimension of BIPQ in patients with RA were arranged as followed:BIPQ-6(illness concern),BIPQ-2(timeline),BIPQ-4(treatment control),BIPQ-1(consequences),BIPQ-5(identity),BIPQ-7(comprehensibility),BIPQ-3(personal control).Genders,education levels,types of residence,family monthly incomes,courses of disease and DAS28 scores were the influential factors of illness perception in patients with RA(P<0.05).2.Eight dimensions of quality of life in patients with RA were compared,two dimensions had lower scores:role physical,general heath.Ages,education levels,courses of disease and DAS28 scores were related to quality of life(P<0.05).3.BIPQ-1(consequences),BIPQ-2(timeline),BIPQ-6(illness concern),BIPQ-7(comprehensibility),BIPQ-8(emotions),the total BIPQ scores were related to quality of life when the demographic factors and disease characteristics were controlled(P<0.05).The results of structural equation modeling indicated that the revised theoretical model of the relationship between illness perceptions and quality of life was consistent with the actual data,and the fitting degree is better,and the matching index is better.Illness perceptions were highly correlated with quality of life,with a correlation coefficient of-0.85.4.Illness perception is an important factor affecting the prognosis of RA patients.Attention should be paid to and help RA patients to establish positives illness perceptions,improve their prognosis and improve their quality of life. |
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