Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Stress is related to pathogenesis and progression of inflammatory autoimmune disorders. The aim of this study is to evaluate the role of patient (pt) self reported stress within a year of clinical presentation, particularly pt reported outcomes (PROs) in patients (pts) with early rheumatoid arthritis (ERA).
Methods: 951 pts in CATCH (Canadian Early Arthritis Cohort), a prospective multicentre observational cohort, who answered a modified stress & life events questionnaire, were included. Psychological (Psych) stress was defined as death of family member, divorce, separation, family stress and financial stress. Physical stress was defined as motor vehicle accident, surgery, major illness and infection. Differences in baseline characteristics and PROs in pts at 6 months and 1 year reporting exposure or not to stress were compared. Differences were compared using Chi-Square tests for categorical and Wilcoxon rank sum test for continuous variables.
Results: Mean age (SD) was 53.8(14.2). Mean symptom duration (SD) was 6.0 (3.1) months, 83% were Caucasian, 73% female and 18% smokers. Features distinguishing pts with exposure to either stress vs. none are noted in Table 1. More pts reporting psych stress were female, living alone, employed and fatigued (p<0.05). More pts reporting physical stress and were female, older, had a higher HAQ score, and more co-morbidities (p<0.05). Symptom duration, AM stiffness, smoking, race, education, income and marital status were not associated with stress. Pain, fatigue and HAQ scores were elevated at 0,6 and 12 months in patients exposed to stress vs. non-exposed though these improved to a similar degree in both groups. (Table2).
Table 1. Patients reporting exposure to psychological or physical stress versus no stress
|
Variables |
No stress |
Psychological stress |
Physical stress |
|
n=454 |
n=307 |
n=69 |
|
|
Age |
54.2±15.0 |
53.0±12.49 |
58.5±12.8* |
|
Female sex |
318(70.0%) |
239(77.9%)* |
39(56.5%)* |
|
Living alone, n (%) |
51(11.4%) |
54(17.7%)* |
11(16.2%) |
|
Employed, n (%) |
238(52.4%) |
191(62.2%)* |
32(46.4%) |
|
Pain (0-10mm) |
5.4± 2.8 |
5.7± 2.7 |
5.5± 3.0 |
|
Fatigue (0-10mm) |
4.8± 3.0 |
5.6± 2.9* |
4.9± 2.7 |
|
DAS28 score |
5.0± 1.5 |
5.0± 1.5 |
5.2± 1.6 |
|
HAQ score |
0.96± 0.70 |
1.01± 0.66 |
1.14± 0.71* |
|
Erosions, n (%) |
100(27.4%) |
72(28.0%) |
18(32.1%) |
|
Co-morbidities, n (%) |
384(84.6%) |
268(87.3%) |
66(95.7%)* |
*p-value < .05, Values are mean ± SD unless indicated
Table 2. Outcomes after 6 months and 1 year in patients exposed to stress versus no stress
|
Variables |
6 month stress + (n=447) |
6 month Stress – (n=392) |
1year stress + (n=463) |
1 year stress – (n=423) |
|
Pain (0-10mm) |
3.5±2.8* |
3.0±2.6 |
3.0±2.6* |
2.7±2.5 |
|
Fatigue (0-10mm) |
3.7±3.0* |
3.3±2.9 |
3.3±2.8* |
2.9±2.7 |
|
DAS28 score |
3.3±1.5 |
3.3±1.5 |
3.0±1.5 |
2.9±1.3 |
|
HAQ score |
0.6±0.6* |
0.5±0.6 |
0.5±0.6* |
0.4±0.6 |
* p < .05, Values are mean ± SD unless indicated
Conclusion: Exposure to stress in ERA pts negatively affects PROs. Given that patient self report of stress may be affected by recall bias and attribution prospective studies on the prevalence and impact of stress in early inflammatory arthritis are needed. Stress may be a significant contextual factor to consider when assessing PROs in long term observational studies of RA.
Disclosure:
Y. A. Kim,
None;
J. E. Salmon,
None;
J. Xiong,
None;
B. Haraoui,
None;
C. A. Hitchon,
None;
E. Keystone,
None;
J. E. Pope,
None;
D. Tin,
None;
J. C. Thorne,
None;
G. Boire,
None;
V. P. Bykerk,
Amgen, Pfizer, Roche, BMS, UCB, Janssen Biotech and Abbott,
2;
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