AB0320 Impact of rheumatoid arthritis on life quality: before and after treatment. (12th June 2018) - Grapton, X.
Abstract : Background: Life quality issues in rheumatoid arthritis (RA) are often spontanously mentioned by patients or identified by rheumatologists. Besides classic follow up parameters like DAS28, we have to consider those issues to improve our patients life quality. Objectives: Explore and quantify the impact of RA on life quality via everyday's life and psychological items and the effect of treatment on them. Methods: RA cases were collected by a group of 20 private practice rheumatologists in the Paris area. Basic informations about the patient and his disease were provided by his rheumatologist. Questionnaire including 12 themes and 41 items was filled in by the patient. Results: 167 cases collected: 82% women, mean age 57 years, 56% moderate and 14% severe disease, 76% ACPA positive, 73% structural damage. Initial DAS28 4, 7. Post treatment DAS28 2.7. Drugs: classic DMARDs 95%, corticosteroids 73%, biological DMARDs 22%, combination therapy 76%. Life quality issues are spontaneously mentioned by 55% of the patients. Before treatment, psychological well-being and housework ability are altered in more than 50% of the patients. Impact on economy, food and social life occurs in less than 25% of the cases. Life quality is mostly altered by pain (85%), then fatigue (75%) and handicap (58%). We find a correlation between the severity of RA and the importance of the impact on psychological well-being, sexual life and hobbies. After treatment, psychological well-being improves in 53% of the patients, and social life, work, getting about and sexual life in 45%–32%. Items improved around 50% of the patients are in order: sleep, relation to other people, feeling excluded, social life, depression, sick leave, concentration problems, anxiety and shopping. We find and improvement in a third of cases in house-keeping, going out, sports and libido. 72% of the patients feel a lack of listening by their families, even under treatment. Conclusions: Treatment of RA, including drugs and associated measures, reduces the frequency of negative impact on life quality. We observe that, when DAS28 drops by 43%, the frequency of RA related repercussions diminishes by 31% (14%–50%) on the chosen items. All the items are impacted by RA before treatment and stay impacted after treatment, but less frequently, except family relations. More than one patient of 2 gains correct sleep and almost half of them aren't depressed or anxious anymore. Impact on social activity and house-keeping activity are less frequently improved. Regarding these facts, the rheumatologist has to accomplish a tight follow-up and suggest, besides drug treatment, associated measures like physiotherapy, professionnel activity and environment adaptation and rest among others. A qualitative evaluation of the improvement will be the subject of a further study. Disclosure of Interest: None declared