Background/Purpose

Patients with rheumatoid arthritis and other rheumatic conditions may have physical deformities and functional limitations which make them vulnerable to health-related stigma.  The objectives of this study were 1) to examine the prevalence of anticipated, enacted (discrimination), and internalized stigma (self-stigma) among people with rheumatologic conditions and 2) to assess the relationships between stigma, medication adherence, and quality of life. 

Methods

We conducted a descriptive cross-sectional study by surveying patients from rheumatology clinics at a Veterans Affairs Healthcare System.  Patients completed five sets of questionnaires including 1) sociodemographic questionnaire, 2) 12- item Chronic Illness Anticipated Stigma Scale (CIASS, score range from 1 [very unlikely] to 5 [very likely]) for anticipated sigma, 3) Neurology Quality-of-Life Stigma short form (Neuro-QoL, score range from 1 [never] to 5 [always]) for enacted and internalized stigma, 4) short form-36v2 (SF-36) for quality of life measurement, and 5) 8-item Morisky Medication Adherence Scale (MMAS-8, score range 0-8.0 with higher scores reflecting better adherence).  Pearson’s correlation and analysis of variance were used to evaluate for any associations and significant differences respectively between stigma scores (anticipated, enacted, and internalized), quality of life, and medication adherence. 

Results

85 adults completed the questionnaires, including 74 males and 11 females.  Mean age was 59 ± 13 years.  The top five diagnoses were rheumatoid arthritis (38.8%), psoriatic arthritis (11.6%), gout (11.6%), osteoarthritis (10.9%), and ankylosing spondylitis (7.8%).  67% of the patients were working or retired.   62% of the participants had poor adherence to rheumatic disease medications.  29.4% of patients were somewhat to very likely to anticipate stigma from coworkers and employers versus 4.7% from family/friends and 9.4% from health care workers.  15.3% of patients were sometimes to always experience internalized stigma and 4.7% were sometimes to always experience enacted stigma.  There was a significant negative correlation between the work-related CIASS stigma scores and the SF-36 physical (p = 0.0003) and mental composite scores (p <0.0001).  Higher work-related CIASS stigma score was significantly correlated with poor medication adherence (p = 0.004). Similarly, when participants were divided into poor versus good medication adherence groups, significantly more people in the poor adherence group were somewhat to very likely to anticipate work-related stigma.

Conclusion

These findings indicate that about 30% of patients with rheumatologic conditions anticipate stigma from co-workers and employers.  Few patients reported anticipated stigma from family and friends, anticipated stigma from healthcare providers, enacted stigma, or internalized stigma.   Anticipated work-related stigma was negatively correlated with mental and physical well-being and with medication adherence. Interventions to reduce anticipated work-related stigma have the potential to improve the health of patients with rheumatic diseases.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-social-stigma-in-rheumatic-diseases-and-correlation-with-quality-of-life-and-medication-adherence/