Arthritis Patients Missing Out on Life-Changing Interventions

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A study published in ACR Open Rheumatology suggests that patients with arthritis experience considerable, but potentially modifiable, interference in routine daily life activities. 

Kristina A. Theis, Ph.D., and colleagues from the Centers for Disease Control and Prevention surveyed 1793 U.S. adults aged 45 and older with doctor-diagnosed arthritis. Between a fifth and a quarter reported “a lot” (versus “a little” or “none”) of arthritis-attributable interference in the four domains of recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%).

“Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life,” the authors wrote.

Such interventions, in addition to greater efforts to control arthritis symptoms therapeutically, include referrals for self-management education and physical activity programs, they explained. 

The new data fit into a growing body of research identifying quality-of-life issues that are important to people living with chronic conditions and that don’t always relate directly to their physical symptoms. 

The respondents to the Arthritis Conditions Health Effects Survey had a median age of 62 years, were mostly women (61%) and non-Hispanic whites (81%) with more than a high school education (52%).

More than 50% reported “a little” or “a lot” of arthritis-attributable interference in each of the four activity domains over the prior 30 days.

Patients reporting the highest prevalence of “a lot” of interference in daily activities attributable to arthritis included those who were unable to work or were disabled (ranging from 53% for social activities to 65% for other domains), those who reported severe symptoms of pain, stiffness, and / or fatigue, those with anxiety / depression (from 35% to 55% across domains), and those reporting little or no confidence in their ability to manage their disease (39%-54%).

Overall, respondents who were unable to work/disabled and those with fair/poor self-rated health had the strongest associations with “a lot” of arthritis-attributable interference in each of the four domains.

“Severe arthritis symptoms distinguish patients with arthritis-attributable interference in routine life activities, but other characteristics (anxiety, depression, low education, and low confidence) may identify additional patients who can benefit from interventions,” the authors wrote.

Arthritis-attributable interference was more common among women than men for both household chores (30% vs. 17%) and errands / shopping (27% vs. 14%).
White patients were less likely to report activity interference with errands / shopping and social activities than were Hispanic or black patients. Other risk factors for arthritis-attributable interference included having a high body-mass index and lower educational attainment.

Health care providers can help patients cope with these issues in several ways. These include encouraging patients to take arthritis-specific self-management education classes and referral to other professionals for occupational therapy, physical therapy, or vocational rehabilitation. Such interventions are evidence-based and widely available, yet underused, the authors noted.

And, they wrote, “As more systems become digital and integrated, there may be a role for electronic medical health records to measure and track routine patient reports of arthritis-attributable interference in routine life domains, flag those at risk for adverse outcomes, and trigger intervention recommendations.”

REFERENCE
K. A. Theis, T. J. Brady, C. G. Helmick, L. B. Murphy, and K. E. Barbour. "Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life," ACR Open Rheumatology. Aug. 6, 2019. DOI 10.1002/acr2.11050