Health-Related Quality of Life in Korean Patients with Rheumatic Diseases

Oh, Kwang Taek; Kwak, Eun Joo; Ju, Eun Kyung; Kim, Tae Hwan; Lee, Ji Hyun; Chung, Won Tae; Choe, Jung Yoon; Bae, Sang Cheol

Abstract

OBJECTIVE
The rheumatic disease is a chronic disease, which can result in a functional disability and impaired health-related quality of life (HRQOL). Recently, the concerns about the HRQOL have been increasing especially in chronic diseases, but there has been no report with Korean patients with rheumatic disease. The objective of this study is to assess HRQOL and the correlation among each measurement and to identify the predictors for HRQOL in Korean patients with rheumatic disease.
METHODS
A cross-sectional study with 100 patients with rheumatoid arthritis (RA), 103 patients with osteoarthritis (OA), 111 patients with systemic lupus erythematosus (SLE), 104 patients with fibromyalgia (FM), 90 patients with ankylosing spondylitis (AS), and 228 healthy persons as control was done. We measured the HRQOL (with 36 item Short Form Health Survey (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG) method), the disease specific health state (with Korean Health Assessment Questionnaire (KHAQ) for RA, Korean Western Ontario and McMaster Universities (KWOMAC) for OA, SLE Disease Activity Index (SLEDAI) & Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) for SLE, Korean Fibromyalgia Impact Questionnaire (KFIQ) for FM, Korean Bath Ankylosing Spondylitis Functional Index (KBASFI) for AS), the psychosocial factors (with Centers for Epidemiologic Studies-Depression (CES-D), social support, social network, self-efficacy scale), and clinical features. We compared the means of each group by Student's t-test and ANOVA test, analyzed the correlation among HRQOL and other variables with Pearson and/or Spearman coefficient, and performed the multiple regression analysis with SF-36 as a dependent variable.
RESULTS
There were significant differences in sociodemographic and clinical features among groups. Therefore these differences were compensated later in multiple regression analysis. The HRQOL of disease group was significantly lower than that of healthy control. Among disease groups, the SF-36 global score was highest in SLE and lowest in FM. The SF-36 physical component summary was highest in SLE and lowest in OA and FM. The SF-36 mental component summary was lowest in FM. The EQ-5D utility was highest in SLE and lowest in OA, RA, and FM. The EQ-5D visual analog scale was highest in SLE and lowest in OA, AS, and FM. The CES-D was highest in FM and the self-efficacy scale was lowest in FM. The social support and social network was highest in SLE and lowest in OA and FM. In correlation analysis, the SF-36 and EQ-5D were well correlated with each other, but SG and TTO were not. In general, the disease specific health state (except SLEDAI & SDI), CES-D, and self-efficacy scale were well correlated with SF-36 & EQ-5D. In multivariate models, in a point of view of 5 diseases as a whole, the statistically significant variables of SF-36 global were age, income, the disease specific health state, and self-efficacy scale. The statistically significant variables of SF-36 PCS were age, income, the disease specific health state, and self-efficacy scale, and the statistically significant variables of SF-36 MCS were age, the disease specific health state, social support, and self-efficacy scale. The disease type itself was a statistically significant variable with all SF-36 scores in multiple regression analysis.
CONCLUSION
These results suggest that HRQOL in Korean patients with rheumatic disease is significantly lower than healthy control and there is a difference in HRQOL among disease types. Among variables, age, disease type, the disease specific health state, CES-D, self-efficacy were most constant meaningful variables correlated with HRQOL. Therefore, the efforts to improve HRQOL for Korean patients with rheumatic disease should be designed to improve the self-efficacy and to alleviate the depression in addition to conventional treatment. In addition, to define the more definite feature of HRQOL in Korean patients with rheumatic disease, the study with more and larger epidemiological controlled disease group and detailed variable adjustment should be done.