Correlates and predictors of disability in vulnerable US Hispanics with rheumatoid arthritis

Karpouzas, George; Dolatabadi, S.; Moran, Rosalinda; Li, Ning; Nicassio, Perry M.; Weisman, Michael H.

doi:10.1002/acr.21689

Cited by 41 publications

(45 citation statements)

References 26 publications

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“…Comparable rates (40%) were reported in another urban multiethnic cohort (8). Depression independently predicted disability both cross-sectionally and over time and was highlighted as the strongest, potentially reversible longitudinal determinant of such disability (5,6).…”

Section: Introductionmentioning

confidence: 83%

“…Such studies indicate more severe self-reported disability and worse functional outcomes (1,(3)(4)(5); depression is highly prevalent and constitutes a pivotal determinant of disability (5)(6)(7). We recently reported that 32% of 251 vulnerable US Hispanics with RA from a single center had moderate depression requiring intervention (5). Comparable rates (40%) were reported in another urban multiethnic cohort (8).…”

Section: Introductionmentioning

confidence: 99%

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Perspectives of Vulnerable US Hispanics With Rheumatoid Arthritis on Depression: Awareness, Barriers to Disclosure, and Treatment Options

Withers

Moran

Nicassio

et al. 2015

Arthritis Care & Research

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Objective: Despite the high prevalence of depression among vulnerable Hispanics with rheumatoid arthritis (RA), many do not disclose it or seek treatment. This study explored patient perceptions of depression, its association with their primary disease, barriers to disclosure, reasons for low utilization of mental health care resources, and culturally acceptable intervention approaches. Methods: Semistructured interviews were conducted with 46 participants with RA. Depression was evaluated using Patient Health Questionnaire 9 (PHQ-9). Results: Thirty-three percent of participants were moderately depressed at the time of the interview, based on PHQ-9 score >10; 12 of 46 patients (26%) stated they were depressed regardless of PHQ-9 score. Depression was perceived as a long-term, severe problem leading to suicide. It was associated with weakness and character flaws, contributing to stigma and reduced likelihood of disclosure. Antidepressants were not acceptable; self-reliance and interventions incorporating interpersonal connections were preferred. Systems-related barriers to disclosure included lack of verbal screening, language barriers, limited clinic visit time, and lack of continuity of care, restricting trust with providers. Conclusion: Rectifying misconceptions, as well as providing education regarding the association between RA and depression, the continuum of symptoms, and the range of experiences incurred are needed to facilitate earlier recognition and reduce stigma. Use, duration, and goals of antidepressant therapy should be clarified. Providers should strive to establish trust and conduct in-person depression screening to facilitate disclosure. Interventions with an interpersonal component, such as support groups or patient navigators, were preferred. Themes emphasizing coping strategies, stress reduction, positive thinking, self-efficacy, and resiliency are likely to be most acceptable.

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Perspectives of Vulnerable US Hispanics With Rheumatoid Arthritis on Depression: Awareness, Barriers to Disclosure, and Treatment Options

Withers

Moran

Nicassio

et al. 2015

Arthritis Care & Research

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“…Developed in 1978, the health assessment questionnaire-disability index (HAQ-DI) remained the gold standard for measuring functional disability in RA [8, 9]. Current epidemiological evidence suggested gender [10], age [11], socioeconomic status (SES) [12], disease duration [11, 12], comorbidities [13, 14], pain [15, 16], disease activity [9, 13], laboratory indexes [17, 18], medication adherence [19], grip strength [17, 20], joints damage [9], anxiety/depression [21, 22], and quality of life [1, 4] were significantly associated with the HAQ-DI in RA patients. Only a study from Finland [20] in RA identified that joint mobility have greatest influence on the HAQ-DI.…”

Section: Introductionmentioning

confidence: 99%

Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis

Zhang

et al. 2017

Health Qual Life Outcomes

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BackgroundAs an important outcome measure among rheumatoid arthritis (RA) patients, functional disability may contribute to unemployment, loss of work productivity, and impaired quality of life. However, little is known about the risk factors of functional disability in Chinese RA patients. This study aimed (1) to examine the prevalence of functional disability in Chinese RA patients; (2) to explore factors associated with the health assessment questionnaire-disability index (HAQ-DI).MethodsA total of 101 RA patients in this cross-sectional study underwent standardized laboratory examinations and responded to the questionnaire for demographic data, the HAQ-DI for functional disability, the Compliance Questionnaire on Rheumatology (CQR) for medication adherence, the Hospital Anxiety and Depression Scale (HADS) for psychological status, and the Short Form 36 health survey (SF-36) for quality of life. Pain, grip/pinch strength, disease activity, and large joint mobility were recorded. Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze the data.ResultsThe mean ± SD age of RA patients was 54.9 ± 11.9 years. Approximately 15.8% RA patients in mainland China experience functional disability (defined as a HAQ-DI score ≥ 1). Long disease duration, pain, high disease activity, a larger number of tender and swollen joints, high C-reactive protein (CRP) level, decreased grip strength, and limitation of shoulder, elbow, wrist, knee, and ankle motion were associated with the HAQ-DI. Participants with functional disability tended to have more severe depressive symptoms and a lower quality of life compared with individuals without functional disability. Stepwise logistic regression analyses found that limitation of wrist extension (P = 0.001) and lower body pain (BP) score (P = 0.001) explained higher HAQ-DI score.ConclusionsThe present study reported that functional disability was common in Chinese RA patients. A low quality of life and limitation of joint mobility had great impacts on functional disability in Chinese RA patients. Targeted and culturally sensitive interventions should be strengthened to delay the onset of disabilities of this population.

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“…The assumption that articular features are the largest contributor to mobility limitation in RA may be unfounded, as other characteristics, such as generalized pain, depression, and fatigue, are also potential contributors (10-12). Body composition may also contribute, since higher fat mass and lower lean mass have been associated with higher disability scores in RA (13), and higher thigh fat and lower thigh muscle density were associated with performance limitation in RA patients (14).…”

Section: Introductionmentioning

confidence: 99%

Indicators of Walking Speed in Rheumatoid Arthritis: Relative Influence of Articular, Psychosocial, and Body Composition Characteristics

Lusa

Amigues

Kramer

et al. 2014

Arthritis Care & Research

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Objective To explore the contributions from and interactions between articular swelling and damage, psychosocial factors, and body composition characteristics on walking speed in rheumatoid arthritis (RA). Methods RA patients underwent the timed 400 meter long-corridor walk. Demographics, self-reported levels of depressive symptoms and fatigue, RA characteristics, and body composition [using whole-body dual-energy X-ray absorptiometry (DXA), and abdominal and thigh computed tomography (CT)] were assessed and their associations with walking speed explored. Results A total of 132 RA patients had data for the 400 meter walk, among whom 107 (81%) completed the full 400 meters. Significant multivariable indicators of slower walking speed were older age, higher depression scores, higher reported pain and fatigue, higher swollen and replaced joint counts, higher cumulative prednisone exposure, non-treatment with disease-modifying anti-rheumatic drugs (DMARDs), and worse body composition. These features accounted for 60% of the modeled variability in walking speed. Among specific articular features, slower walking speed was primarily correlated with large/medium lower-extremity joint involvement. However, these articular features accounted for only 21% of the explainable variability in walking speed. Having any relevant articular characteristics was associated with a 20% lower walking speed among those with worse body composition (p<0.001) compared with only a 6% lower speed among those with better body composition (p-value for interaction=0.010). Conclusions Psychosocial factors and body composition are potentially reversible contributors to walking speed in RA. Relative to articular disease activity and damage, non-articular indicators were collectively more potent indicators of an individual's mobility limitations.

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Correlates and predictors of disability in vulnerable US Hispanics with rheumatoid arthritis

Cited by 41 publications

References 26 publications

Perspectives of Vulnerable US Hispanics With Rheumatoid Arthritis on Depression: Awareness, Barriers to Disclosure, and Treatment Options

Perspectives of Vulnerable US Hispanics With Rheumatoid Arthritis on Depression: Awareness, Barriers to Disclosure, and Treatment Options

Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis

Indicators of Walking Speed in Rheumatoid Arthritis: Relative Influence of Articular, Psychosocial, and Body Composition Characteristics

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