Self-rated health in patients with rheumatoid arthritis is associated with health-related quality of life but not with clinical variables

Abstract

Objectives: Self-rated health (SRH) is a well-known overall health status measure used in the general population but it is rarely examined in a clinical setting. We assessed SRH-related factors in clinic-based patients with rheumatoid arthritis (RA).

Method: The study included 123 consecutive outpatients treated in 1998–1999. Patient questionnaires, including a single SRH item, sociodemographics, the Health Assessment Questionnaire (HAQ) for functional ability, and the Nottingham Health Profile (NHP) for health-related quality of life (QoL), were collected at baseline. Comorbidities were measured by the Charlson Comorbidity Index (CCI) and data on the use of drugs and surgery for RA were verified from medical records and by querying patients. Factors associated with SRH were examined using regression models with the propensity score as the covariate. Mortality rates were collected up to 31 December 2014. Hazard ratios (HRs) were used to estimate SRH-associated mortality.

Results: In univariate analysis, poor SRH was associated with higher age and poorer patient-reported outcomes (PROs) but not with gender and clinical variables. After adjustment for the propensity score, the NHP dimensions for pain, energy, emotional reactions, and mobility remained significantly associated with SRH. The age- and sex-adjusted HR for death was 2.38 [95% confidence interval (CI) 1.13–5.04, p = 0.034] for the patients with poor vs. good SRH. The propensity score-adjusted HR for death was 1.69 (95% CI 0.74–3.86, p = 0.21).

Conclusions  In patients with RA, SRH was associated with health-related QoL dimensions, reflecting patients’ well-being rather than clinical factors. During the 16 years of follow-up, SRH had no independent association with mortality.

Acknowledgements

We thank the patients with RA for participating in this study, and the rheumatology staff of the Central Hospital of Lapland and research assistant Pia Jauhiainen from Medcare Foundation for their help during the study. This study was supported by grants from the Central Hospital of Lapland and Oulu University Hospital (EVO funding), Finland.