Original Article
Health Related Quality of Life in Rheumatoid Arthritis, Osteoarthritis, Diabetes Mellitus, End Stage Renal Disease and Geriatric Subjects. Experience From a General Hospital in MexicoCalidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México☆

https://doi.org/10.1016/j.reumae.2014.03.014Get rights and content

Abstract

Introduction

Chronic diseases have a great impact on the morbidity and mortality and on the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases.

Objectives

The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, and end-stage renal disease, in geriatric subjects and in a control group.

Patients and methods

We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met the classification criteria for RA, OA, diabetes mellitus, and end-stage renal disease; the geriatric subjects group was aged ≥65 years and the control group ≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analog scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea.

Results

We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and the rest of groups: 160). Differences were detected in baseline characteristics (P<.0001). The SF-36 scores were different between the control group and other groups (P=.007). The worst HRQoL was observed in the end-stage renal disease group (SD: 48.06±18.84x/SD). General health was the principal affected area in RA. Pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±.76 vs .82±.82, respectively; P=.001). Forty-five percent of all subjects had depression.

Conclusions

The HRQoL in RA patients is poor and comparable to that of other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered as high impact diseases and therefore should receive more attention.

Resumen

Introducción

Las enfermedades crónicas impactan en la morbimortalidad y en la calidad de vida relacionada con la salud (CVRS) de los pacientes a nivel mundial. El impacto de las enfermedades reumáticas no ha sido totalmente reconocido.

Objetivos

Determinar la CVRS y evaluar áreas específicas en artritis reumatoide (AR), osteoartritis (OA), diabetes mellitus, insuficiencia renal terminal, población geriátrica y un grupo control.

Pacientes y métodos

Estudio transversal, realizado en el Hospital General de Morelia. Los sujetos cumplían criterios para AR, OA, diabetes mellitus, insuficiencia renal terminal, un grupo de población geriátrica (≥ 65 años) y un grupo control ≥ 30 años. Se determinaron características sociodemográficas y se aplicaron instrumentos: SF-36, escala visual analógica de dolor, valoración global del paciente y médico, inventario para depresión de Beck, e instrumentos específicos (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] y Kidney Disease Questionnaire of Life [KDQOL]). Mediciones bioquímicas: velocidad de sedimentación globular (VSG), biometría hemática (BH), glucosa, HbA1C, creatinina y urea.

Resultados

Fueron evaluados 290 sujetos (un grupo control: 100, población geriátrica 30 y 160 en los demás grupos). Se detectaron diferencias (p < 0,0001) en las características basales. Los puntajes del SF-36 fueron diferentes entre los grupos (p = 0,007). La peor CVRS se observó en el grupo de insuficiencia renal terminal (media ± DE: 48,06 ± 18,84). En el grupo de AR la salud en general fue el área más afectada. El dolor fue mayor en las enfermedades reumáticas: OA (5,2 ± 2,4) y AR (5,1 ± 3). El HAQ-Di fue mayor en OA comparado con AR (1,12 ± 0,76 vs. 0,82 ± 0,82 respectivamente; p = 0,001). El 45% de los sujetos tuvo depresión.

Conclusiones

La CVRS en pacientes con AR es mala y equiparable a lo que sucede en pacientes con enfermedades crónicas (insuficiencia renal terminal y diabetes mellitus). Las enfermedades reumáticas deben considerarse padecimientos de alto impacto y por ello merecen mayor atención.

Introduction

Quality of life related to health (HRQoL) is a multidimensional concept, related to the individual impact of the disease and its treatment, as well as functional capacity and the patient's perception in social, physical and mental1 roles.

Rheumatoid arthritis (RA) and osteoarthritis (OA) are two common rheumatic diseases associated with impaired physical function and HRQoL, affecting different age groups, most of them in2 productive stages of life.

Chronic diseases impact on morbidity and quality of life of patients worldwide, and are responsible for 72% of the total burden of disease.3 It is well known that end-stage renal disease (ESRD) and diabetes mellitus (DM) have a great impact on a patient's physical, mental and emotional role.4, 5, 6

The instruments to assess quality of life can be generic and specific. Generic instruments such as the SF-36 questionnaire allow us to compare HRQoL between chronic diseases (DM and ESRD) and rheumatic diseases (RA and OA).7

The level of activity of rheumatic diseases correlates inversely with HRQoL; one of the instruments used to determine the activity in RA is the Disease Activity Score (DAS-28),8 and, for OA, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which allows us to determine the degree of functional compromise.

The specific instruments used for estimating HRQoL in ESRD and DM (DQOL and KDQOL SF) explore points such as satisfaction with glycemic control, dialysis sessions and drug therapy.9, 10

It is well known that HRQoL is reduced in rheumatic diseases as well as metabolic diseases, and this aspect has become so important that it is one of the main primary outcomes used to determine the effectiveness of treatments in each disease.

Rheumatic diseases have not been fully recognized as having a high impact on HRQoL. No information about the comparison of the quality of life of chronic diseases and rheumatic diseases exists in our country, and for that reason, we decided to evaluate HRQoL in two rheumatic diseases (RA, OA), 2 chronic diseases with high medical and social impact (DM and ESRD), a group of geriatric patients and a control group.

Section snippets

Patients and Methods

This was a cross-sectional study which included consecutive patients attending the rheumatology, internal medicine, endocrinology and nephrology clinics in Morelia, Michoacán's General Hospital “Dr. Miguel Silva”, within a one year period. The patients met the classification criteria of the American College of Rheumatology for RA or OA11, 12 (hip and knee) and the criteria of the American Diabetes Society 200413 for DM (at least 2 years of evolution), and the ESRD group14 was undergoing renal

Results

We evaluated 290 subjects distributed as follows: 100 in the control group with an age of 53±11.2 years (mean±SD), 30 subjects in the geriatric population with 72.8±7, 3 years of age and 40 subjects in each group with different diseases (RA, OA, DM, and ESRD). The average age in the rest of the groups was as follows: RA, 52.4±16.2 years; OA, 63.4±15.2 years; DM2, 58.6±14 years; and ESRD, 40.38±18.5. Differences in baseline characteristics were detected regarding the instruments used to assess

Discussion

This study describes the findings in HRQoL in 4 chronic diseases. The quality of life was low in all the groups, consistent with previous studies.20, 21 Differences were seen in the perception of pain and disability, which were higher in the groups of rheumatic disease. The lowest level of HRQoL was found in the ESRD group followed by the RA and OA groups.

There are no similar studies in Mexico. A Swedish study published by Arne et al.22 has similar results. They compared HRQoL in patients with

Protection of people and animals

The authors declare that in this research no experiments was performed on humans or animals.

Data confidentiality

The authors declare that they have followed the protocols of their workplace on the publication of data from patients, and all patients included in the study have received sufficient information and gave written informed consent to participate in the study.

Right to privacy and informed consent

The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the

Conflict of Interest

The authors have no conflicts of interest.

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    Please cite this article as: Ambriz Murillo Y, Menor Almagro R, Campos-González ID, Cardiel MH. Calidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México. Reumatol Clin. 2015;11:68–72.

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