Counseling Points - November 2008 - (Page 4)

Quality of Life and Treatment Options in Rheumatoid Arthritis RA and Quality of Life Rheumatoid arthritis (RA) has a markedly negative impact on the quality of life of patients.1,2 The profound pain and fatigue associated with the disease limit functional ability, diminish physical energy, and contribute to emotional distress. Optimal treatment involves a comprehensive program that includes pharmacological as well as nonpharmacological modalities aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life.2 Recognizing that emotional status can greatly influence physical symptoms and disease course, a number of instruments have been developed to assess quality of life in patients with RA. www.chcr.brown.edu/pcoc/EHAQDESCRSCORING HAQ372.PDF. The World Health Organization Quality of Life (WHOQOL-BREF) Instrument The WHOQOL-BREF is an international, cross-cultural, quality-of-life assessment tool.4 It evaluates individuals’ perceptions in the context of their culture, value system, and personal concerns. The WHOQOL-BREF includes 26 items that measure four broad domains: physical health, psychological health, social relationships, and environment. Like the HAQ, the WHOQOL-BREF is available in many different languages.4 A copy of the form and user manual is available at: www.who.int/mental_health/ evidence/who_qol_user_manual_98.pdf. The Health Assessment Questionnaire (HAQ) One of the most widely used and reliable quality-of-life assessment tools is the Health Assessment Questionnaire (HAQ).3 Introduced in 1980, it is among one of the first patient-reported outcome instruments designed to represent a model of how patients regard their disease. Results from the HAQ can provide a comprehensive measure of disease outcomes in RA and other rheumatic diseases, including osteoarthritis, juvenile rheumatoid arthritis, lupus, scleroderma, ankylosing spondylitis, fibromyalgia, and psoriatic arthritis. The HAQ has also been used to evaluate HIV/AIDs patients, normal aging individuals, and disabled workers. Scoring is determined from responses in five patient-centered dimensions: disability, pain, medication effects, costs of care, and mortality. One of two HAQ versions is typically used to assess patients—the full questionnaire, which evaluates all five domains, and a shorter two-page form that only includes the HAQ disability index (HAQ-DI) and pain visual analog scales (VAS).3 Both HAQ versions have been translated into more than 60 languages and are readily available online at: COUNSELING POINTS™ 4 Improving Quality of Life Living with a chronic, debilitating illness such as RA can be intensely stressful for individuals. However, disease education and self-empowerment can help to ameliorate feelings of anger, frustration, anxiety, and grief.5 Nurses who treat RA patients should provide them with disease education and encourage individuals to evaluate the causes of anxiety and learn new ways to adapt to and manage stress. Measures such as psychotherapy, rest and relaxation, a healthy diet, and other approaches may ease psychological distress and reduce physical pain symptoms associated with RA.5 Relieving Emotional Stress It is important for patients to understand that the physical stress RA exerts on joints can trigger emotional distress, which can ultimately exacerbate joint pain. 5,6 Current research is examining the association between the levels of damaging cortisol production in RA and control of external stressors. Interestingly, processes that induce the immune system to activate and proliferate inflammationpromoting cytokines are the same processes that are stimu- http://www.chcr.brown.edu/pcoc/EHAQDESCRSCORINGHAQ372.PDF http://www.chcr.brown.edu/pcoc/EHAQDESCRSCORINGHAQ372.PDF http://www.who.int/mental_health/evidence/who_qol_user_manual_98.pdf http://www.who.int/mental_health/evidence/who_qol_user_manual_98.pdf

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Counseling Points - November 2008 Welcome Quality of Life and Treatment Options in Rheumatoid Arthritis Counseling Points

Counseling Points - November 2008

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