Stressful life events precede RA diagnosis in adult patients

More than half of the patients with a newly diagnosed rheumatoid arthritis (RA) have experienced stressful life event in the year prior to their diagnosis, according to a study.

These stressful events are associated with worse disability, depression, pain, fatigue, sleep, and well-being at diagnosis.

A group of researchers obtained data from 1,933 adults with RA in the Canadian Early Arthritis Cohort, a multicentre inception cohort from January 2007 to March 2018, with more than 12 months of follow-up. Participants (mean age 55 years) then completed the following questionnaires in the previous year: Health Assessment Questionnaire–Disability Index (HAQ-DI); 12-item Short Form Health Survey; and 11-point rating scales of sleep, fatigue, pain, and patient global assessment (PtGA).

The researchers compared group characteristics using ANOVA or chi-square test and examined the effect of stressors on symptoms and functions at 1 year using adjusted multivariable regression models.

Of the participants, 87 percent were White individuals and 72 percent were women. More than half (52 percent) of them reported experiencing at least one stressor in the year prior to diagnosis. Around diagnosis, RA patients who reported major stressors showed significantly worse mean HAQ-DI, depression, sleep, fatigue, pain, and PtGA, which worsened with the type and number of stressors.

At 1 year, the likelihood of depression and disability and ratings of pain, fatigue, poor sleep, and PtGA rose with an increasing number of stressors. However, the Simplified Disease Activity Index (SDAI) showed similar improvement across groups.

“Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI,” the researchers said. “Results highlight the potential independent contributions of environmental and psychological factors in the onset and course of RA.”