Session Type: Abstract Submissions (ACR)
Background/Purpose: Illness perceptions (IP) are the beliefs and expectations that an individual has about medical conditions. IP have been found to cluster around five coherent themes (identity; cause; time-line; consequences; and cure/control). Positive IPs have been associated with higher adherence, better disease outcomes and wellbeing in several chronic diseases. Relatively less is known about how illness perceptions impact patient perceptions of wellbeing and other disease outcomes in rheumatoid arthritis (RA).
Methods: Consecutive English speaking RA patients seen at an academic center between 2013- 2014 were asked to complete the Illness Perception Questionnaire – Revised (IPQ-R). Clinical RA indicators were obtained at each visit. Spearman correlations were calculated between IPQ-R scales and CDAI. Adjusted regression models evaluated the effect of IPQ-R on patient global scores.
Results: 50 RA patients completing the survey were mostly female (n=38;76%) with a mean (SD) education of 15 (4) yrs, and median (IQR) HAQ score of .25 (1.0). Eight (16%) had an RA duration ≤ 1 year and 20 (40%) of 1-5 years. Most were seropositive for RF (61%) and anti-CCP (66%); 15 (30%) were on biologics. CDAI scores classified 13 (26%) in remission and 18 (36%), 13 (26%) and 6 (12%) with low, moderate and high disease activity levels, respectively.
Timeline-Cyclic (rho = .32) and Personal Control (rho = .28) were significantly (p’s <.05) and directly associated with CDAI; Treatment Control (rho = -.40) was inversely related to CDAI in a dose response manner (mean difference 2.3 and 3.8 between remission, low, and mod-high levels). After controlling for disease activity, Treatment Control and Emotional Representations were independent additional predictors (p’s <.05) explaining 62% of the variance in patient global scores. Genetic risk factors (39%), altered immunity (26%) and psychological factors (24%) were viewed as the primary reason or an important contributing factor for developing RA. Patients who attributed their RA to psychological factors had significantly higher mean Cyclical Timeline scores (14.8 vs. 12.1; p=.004) reflecting attitudes of greater unpredictability and uncertainty around their disease.
Conclusion: Understanding patients’ beliefs about the cause of their RA, as well as expectations about controllability, may offer insight into patient behaviors (e.g., adherence to treatment) that impact long-term outcomes. Beliefs about causes of RA may also affect expectations of whether and how the disease can be controlled. Clinicians may find useful to directly explore patients’ expectancies around treatment, and to provide hope, encouragement and ongoing support when expectations are low.
S. J. Bartlett,
M. C. Bazan Bardales,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/beyond-disease-activity-patient-global-scores-also-reflect-treatment-expectations-and-emotional-reactions-to-living-with-rheumatoid-arthritis/