Psychological well-being in early rheumatoid arthritis:

Transcription

1 Psychological well-being in early rheumatoid arthritis: Findings from the Early Rheumatoid Arthritis Network (ERAN) Sam Norton,* Patrick Kiely, David Walsh, Richard Williams & Adam Young *Cambridge Institute of Public Health 2 May 2012

2 Background Psychological well-being in rheumatoid arthritis is known to be reduced compared to the general population (Dickens et al, 2002) Longitudinal studies suggest that it is stable over time (e.g. Barlow et al, 1998; Brekke et al, 2003) However, some evidence that it is lower early in the course of the disease (Odegard et al, 2007; Schieir et al, 2009; Norton et al, 2011) Aim: To examine longitudinal changes in psychological well-being in a large sample of patients with recent onset RA Identify factors related to psychological well-being at presentation and changes in psychological well-being over time

3 Early Rheumatoid Arthritis Network (ERAN) Prospective observational cohort recruiting DMARD naïve patients at presentation from 21 centres in the UK and Ireland In total, 1235 patients were recruited between 2002 and September 2011 Patients were re-assessed after 3-6 months, 12 months and then yearly Available data over 5-years was used: N base = 1235, N 3-6m = 922, N 12m = 860, N 24m = 712, N 36m = 576, N 48m = 458, N 60m = 314

4 Psychological well-being Quality of life was assessed using the SF36v2 Used SF36 Mental Health (SF36-MH) scores as markers of psychological well-being Scores were normed against the UK general population (mean=50, SD=10) Missing SF36 data around 20% at each visit, and 10% have no SF36-MH score recorded at any visit

5 Baseline demographic and clinical characteristics N Mean Std. Dev. Age Female % HAQ DAS Tender joints Swollen joints ESR CRP

6 Mean psychological well-being over time 51 Normed SF36-MH score N= Disease duration (years)

7 Mixed-effects model Linear mixed-effects model for change in psychological well-being over time N = 1108 with at least one SF36-MH score Random intercept: Mean = 47.1; SD = 7.1 Random slope: Mean = 0.5; SD = 1.1 Baseline level Rate of change b 95% CI b 95% CI Age 0.09 ( 0.06, 0.13 ) ( -0.04, 0.00 ) Female ( -1.71, 0.55 ) ( -0.55, 0.30 ) BMI 0.04 ( -0.06, 0.14 ) ( -0.08, 0.00 ) Smoker ( -1.44, 0.67 ) 0.03 ( -0.40, 0.47 ) HAQ ( -3.11, ) ( -0.45, 0.40 ) DAS ( -0.79, 0.19 ) 0.01 ( -0.19, 0.21 ) CRP 1.00 ( 0.26, 1.75 ) ( -0.42, 0.23 ) Erosions 0.53 ( -0.56, 1.62 ) ( -0.41, 0.39 ) SF36 vitality 0.45 ( 0.39, 0.51 ) ( -0.09, )

8 Mean psychological well-being over time: Age Normed SF36-MH score Age mean mean - 1SD mean + 1SD Disease duration (years) Note: Mean = 57.1; SD = 14.0

9 Mean psychological well-being over time: BMI Normed SF36-MH score BMI mean mean - 1SD mean + 1SD Disease duration (years) Note: Mean = 27.6; SD = 5.3

10 Mean psychological well-being over time: Vitality Normed SF36-MH score SF36 vitality mean mean - 1SD mean + 1SD Disease duration (years) Note: Mean = 41.7; SD = 11.1

11 Conclusion Psychological well-being in early RA, prior to the use of disease modifying therapy, is reduced compared to the general population Over time psychological well-being normalises but takes longer in those who are younger, have higher BMI and report lower baseline vitality While baseline disease characteristics, mainly HAQ, explain differences in baseline psychological well-being they are not related to change over time

12 Acknowledgments ERAN Centres Clinician Metrologist Aylesbury Dr M Webley/Dr S Edmonds J Hall Basingstoke Dr P Prouse S Andrews Bristol Dr P Creamer J Taylor/G Bath Christchurch Dr C Dunne L Hawley Enfield Dr J Griffin P Goodman Haverfordwest Dr A Coulson/Dr S Sunil S Morris Hereford Dr R Williams K Blunn/J McDowell/H Robinson Lancaster Dr M Bukhari/Dr J Halsey B Evans/J Kaye GKT, London Dr E Choy R Chura St Georges, London Dr P Kiely F Leone Mansfield Dr D Walsh & Dr N Carter D Wilson Oxford Dr J David M Cox St Albans Dr A Young A Seymour Stoke-on-Trent Dr A Hassell M Kirwan Waterford, Ireland Dr J Devlin C Duffy Weston-super-Mare Dr S Clarke/Dr S Green B Williams Yeovil Dr T Palferman/Dr S Knights C Buckley/R Rowland-Axe Collaborators Medical Research Council (MRC) Clinical Trials Unit, London Project Coordinator Marie Hunt Rheumatology Research & Audit Office St Albans City Hospital Waverley Road St Albans, Herts AL3 5PN ENGLAND Tel: (+44) marie.hunt@whht.nhs.uk Health Care Commission The Healthcare Commission exists to promote improvements in the quality of healthcare and public health in England and, to a lesser degree, Wales. In England, the Commission is responsible for assessing and reporting on the performance of both NHS and independent healthcare organisations, to ensure that they are providing a high standard of care. We also encourage providers to continually improve their services and the way they work.