Op0348 pare Face Arthritis: What Situations Affect Emotionally the Patient With Rheumatoid Arthritis and How to Resolve Them Effectively

Abstract

BackgroundWHO defines health as a state of physical, psychological and social well-being. However, patients with rheumatoid arthritis (RA) declare that treatment is mainly aimed at combating physical affectation and hardly focusses on emotional and social aspects.ObjectivesTo identify the situations that produce the greatest negative emotional impact in RA patients and to assess the coping strategies used.MethodsA previous phase (Project OpinAR) (1) identified situations with negative emotional and social impact. In this project, 2 stages were developed: a) A nominal group of patients, following the McMillan method, selected the most emotionally affected situations from the previous list; b) Voting of patients and rheumatologists to assess the assumed effectiveness of 8 coping strategies for each situation with a Likert scale of 1 to 10 (minimum and maximum): proactive resolution, self-criticism, emotional expression, desiderative thinking, social support, cognitive restructuring, avoidance of problems and social withdrawal. The median, interquartile range (IQR), and statistical significance of the differences between patients and physicians (Student’s T test) were calculated with a cut-off value of p=0.05. The strategies valued with 8, 9 and 10 were recommended and those valued as 1, 2 or 3 were discouraged. The study was approved by the Ethical Research Committee of the Hospital of La Princesa.Results107 patients from all the Autonomous Communities and 31 expert rheumatologists from 13 Autonomous Communities were recruited, of which 100 (93%) and 17 (55%) participated in the study in a valid way, respectively.The four situations that most negatively affect them, in the opinion of patients and their doctors are: i) The patient feels that his disease evolves worse than what the doctor says, ii) The patient does not know aspects of the control and monitoring of his disease, iii) The patient feels that he does not really participate in the decision making, and iv) The patient is dissatisfied with the overall treatment received. Regarding coping strategies, doctors recommended using proactive resolution in all situations more frequently than patients (p<0.05 for all situations, low variability, with IQR ≤2 among physicians) as well as emotional expression (p<0.05 for 3 situations, high variability, with IQR ≥3). Other strategies were less valued by doctors and patients, but with similar responses. There was a lot of dispersion (IQR >1) in most cases.ConclusionThe situations with the greatest negative emotional impact on RA are those that put the doctor and the patient at odds with regard to the perception of the disease and its control and should be treated during visits. The most recommended strategies are proactive resolution and emotional expression. The most discouraged are self-criticism and the avoidance of the problem. Anyway, there is a great variability of opinions and doctors tend to give more extreme responses. Doctors and patients should have a space and willingness to discuss and exchange opinions on how...