Abstract
OBJECTIVES--To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. METHODS--The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. RESULTS--Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. CONCLUSIONS--We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
- Crotty M., Ahern M. J., McFarlane A. C., Brooks P. M. Clinical rheumatology training of Australian medical students. A national survey of 1991 graduates. Med J Aust. 1993 Jan 18;158(2):119–120. [PubMed] [Google Scholar]
- Edwards W. Etodolac, aspirin, and placebo in patients with rheumatoid arthritis: a 12-week study. Clin Ther. 1983;5(5):495–503. [PubMed] [Google Scholar]
- Hagglund K. J., Haley W. E., Reveille J. D., Alarcón G. S. Predicting individual differences in pain and functional impairment among patients with rheumatoid arthritis. Arthritis Rheum. 1989 Jul;32(7):851–858. [PubMed] [Google Scholar]
- Hawley D. J., Wolfe F. Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients. J Rheumatol. 1988 Jun;15(6):932–941. [PubMed] [Google Scholar]
- Juby A., Davis P. Psychological profiles of patients with upper gastrointestinal symptomatology induced by non-steroidal anti-inflammatory drugs. Ann Rheum Dis. 1991 Apr;50(4):211–213. doi: 10.1136/ard.50.4.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Langley G. B., Sheppeard H., Wigley R. D. Placebo therapy in rheumatoid arthritis. Clin Exp Rheumatol. 1983 Jan-Mar;1(1):17–21. [PubMed] [Google Scholar]
- Manne S. L., Zautra A. J. Coping with arthritis. Current status and critique. Arthritis Rheum. 1992 Nov;35(11):1273–1280. doi: 10.1002/art.1780351106. [DOI] [PubMed] [Google Scholar]
- McFarlane A. C., Brooks P. M. An analysis of the relationship between psychological morbidity and disease activity in rheumatoid arthritis. J Rheumatol. 1988 Jun;15(6):926–931. [PubMed] [Google Scholar]
- McFarlane A. C., Brooks P. M. Determinants of disability in rheumatoid arthritis. Br J Rheumatol. 1988 Feb;27(1):7–14. doi: 10.1093/rheumatology/27.1.7. [DOI] [PubMed] [Google Scholar]
- Parker J. C., Buckelew S. P., Smarr K. L., Buescher K. L., Beck N. C., Frank R. G., Anderson S. K., Walker S. E. Psychological screening in rheumatoid arthritis. J Rheumatol. 1990 Aug;17(8):1016–1021. [PubMed] [Google Scholar]
- Parker J., Frank R., Beck N., Finan M., Walker S., Hewett J. E., Broster C., Smarr K., Smith E., Kay D. Pain in rheumatoid arthritis: relationship to demographic, medical, and psychological factors. J Rheumatol. 1988 Mar;15(3):433–437. [PubMed] [Google Scholar]
- Pincus T., Callahan L. F., Bradley L. A., Vaughn W. K., Wolfe F. Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status. Arthritis Rheum. 1986 Dec;29(12):1456–1466. doi: 10.1002/art.1780291206. [DOI] [PubMed] [Google Scholar]
- Streiner D. L. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry. 1994 Apr;39(3):135–140. doi: 10.1177/070674379403900303. [DOI] [PubMed] [Google Scholar]
- WALKER E. R. C. Some important issues of the National Health Service. Br Med J. 1952 Nov 8;2(Suppl 2494):181–183. [PMC free article] [PubMed] [Google Scholar]