Clinical Rheumatology

, Volume 31, Issue 10, pp 1471–1477 | Cite as

Health-related quality of life in Moroccan patients with rheumatoid arthritis

  • Yousra Ibn YacoubEmail author
  • Bouchra Amine
  • Assia Laatiris
  • Najia Hajjaj-Hassouni
Original Article


We aimed to assess the aspects of health-related quality of life (HRQoL) in Moroccan patients with rheumatoid arthritis (RA) and to evaluate the disease-related parameters influencing it. Two hundred fifty-five patients with RA were consecutively included. We assessed sociodemographic characteristics, cigarette smoking status, disease duration, diagnosis delay, joint pain intensity (on a 0–100-mm visual analogue scale), disease activity (by the disease activity score (DAS 28) and biological tests), structural damage (by radiographs scored using the Sharp’s method as modified by Van der Heijde), functional disability (by the Health Assessment Questionnaire), extra-articular manifestations, immunological status, and treatments. The Arabic version of the Medical Outcomes Study Short Form 36 Health Survey (SF-36) was applied to assess HRQoL. All domains of SF-36 were deteriorated in a significant way comparing to the general population. The most affected subgroups of SF-36 were role limitation, role emotional, vitality, and social functioning. Women had significantly lower scores of SF-36 compared to men. Patients with decreased levels of education and low socioeconomic status had significantly lower scores of SF-36 (for all p ≤ 0.01). Current and ex-smokers had lower scores in physical domains of quality of life. Patients treated with methotrexate had better scores of mental health. Furthermore, patients receiving biologic agents had better scores of physical and social domains. Decreased scores of SF-36 were significantly correlated with disease duration, joint pain intensity, clinical and biological disease activity, functional disability, and radiographic damage. The level of antibodies against citrullinated peptides had significant correlations with the impairment of physical domains of SF-36. Physical as well as mental aspects of HRQoL in our RA patients were significantly deteriorated. Recognizing complicated relationships between HRQoL and disease-related variables among our RA patients can help to develop further management strategies to improve patients’ daily living particularly with the advent of new treatments.


Quality of life Rheumatoid arthritis 





  1. 1.
    Kosinski M, Kujawski SC, Martin R, Wanke LA, Buatti MC, Ware JE Jr, Perfetto EM (2002) Health-related quality of life in early rheumatoid arthritis: impact of disease and treatment response. Am J Manag Care 8(3):231–240PubMedGoogle Scholar
  2. 2.
    Lubeck DP (2002) Health-related quality of life measurements and studies in rheumatoid arthritis. Am J Manag Care 8(9):811–820PubMedGoogle Scholar
  3. 3.
    Rupp I, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos GA (2004) Impact of fatigue on health-related quality of life in rheumatoid arthritis. Arthritis Rheum 51(4):578–585PubMedCrossRefGoogle Scholar
  4. 4.
    West E, Wållberg-Jonsson S (2009) Health-related quality of life in Swedish men and women with early rheumatoid arthritis. Gend Med 6(4):544–554PubMedCrossRefGoogle Scholar
  5. 5.
    Keystone E, Burmester GR, Furie R, Loveless JE, Emery P, Kremer J, Tak PP, Broder MS, Yu E, Cravets M, Magrini F, Jost F (2008) Improvement in patient-reported outcomes in a rituximab trial in patients with severe rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Arthritis Rheum 59(6):785–793PubMedCrossRefGoogle Scholar
  6. 6.
    Kvien TK, Uhlig T (2005) Quality of life in rheumatoid arthritis. Scand J Rheumatol 34:333–341PubMedCrossRefGoogle Scholar
  7. 7.
    Haroon N, Aggarwal A, Lawrence A, Agarwal V, Misra R (2007) Impact of rheumatoid arthritis on quality of life. Mod Rheumatol 17(4):290–295PubMedCrossRefGoogle Scholar
  8. 8.
    Alishiri GH, Bayat N, Fathi Ashtiani A, Tavallaii SA, Assari S, Moharamzad Y (2008) Logistic regression models for predicting physical and mental health-related quality of life in rheumatoid arthritis patients. Mod Rheumatol 18(6):601–608PubMedCrossRefGoogle Scholar
  9. 9.
    Minnock P, Fitzgerald O, Bresnihan B (2003) Quality of life, social support, and knowledge of disease in women with rheumatoid arthritis. Arthritis Rheum 49(2):221–227PubMedCrossRefGoogle Scholar
  10. 10.
    Söderlin MK, Lindroth Y, Jacobsson LT (2007) Trends in medication and health-related quality of life in a population-based rheumatoid arthritis register in Malmo, Sweden. Rheumatol (Oxford) 46(8):1355–1358CrossRefGoogle Scholar
  11. 11.
    Khoudri I, Ali Zeggwagh A, Abidi K, Madani N, Abouqal R (2007) Measurement properties of the short form 36 and health-related quality of life after intensive care in Morocco. Acta Anaesthesiol Scand 51(2):189–197PubMedCrossRefGoogle Scholar
  12. 12.
    Tugwell P, Idzerda L, Wells GA (2008) Generic quality-of-life assessment in rheumatoid arthritis. Am J Manag Care 14(4):234PubMedGoogle Scholar
  13. 13.
    Bedi GS, Gupta N, Handa R, Pal H, Pandey RM (2005) Quality of life in Indian patients with rheumatoid arthritis. Qual Life Res 14(8):1953–1958PubMedCrossRefGoogle Scholar
  14. 14.
    Abourazzak FE, Benbouazza K, Amine B, Bahiri R, Lazrak N, Bzami F, Jroundi I, Abouqal R, Guillemin F, Hajjaj-Hassouni N (2008) Psychometric evaluation of a Moroccan version of health assessment questionnaire for use in Moroccan patients with rheumatoid arthritis. Rheumatol Int 28(12):1197–1203PubMedCrossRefGoogle Scholar
  15. 15.
    Van der Heijde DM, van Leeuwen MA, van Riel PL, van de Putte LB (1995) Radiographic progression on radiographs of hands and feet during the first 3 years of rheumatoid arthritis measured according to Sharp’s method (van der Heijde modification). J Rheumatol 22(9):1792–1796PubMedGoogle Scholar
  16. 16.
    West E, Jonsson SW (2005) Health-related quality of life in rheumatoid arthritis in Northern Sweden: a comparison between patients with early RA, patients with medium-term disease and controls, using SF-36. Clin Rheumatol 24(2):117–122PubMedCrossRefGoogle Scholar
  17. 17.
    Lapsley HM, March LM, Tribe KL, Cross MJ, Courtenay BG, Brooks PM (2002) Living with rheumatoid arthritis: expenditures, health status, and social impact on patients. Ann Rheum Dis 61:818–821PubMedCrossRefGoogle Scholar
  18. 18.
    Spratt JE (1992) Women and literacy in Morocco. Ann Am Acad Political Soc Sci 520:121–132CrossRefGoogle Scholar
  19. 19.
    Boutayeb A, Serghini M (2006) Health indicators and human development in the Arab region. Int J Health Geogr 5:61PubMedCrossRefGoogle Scholar
  20. 20.
    Vliet Vlieland TP, Buitenhuis NA, van Zeben D, Vandenbroucke JP, Breedveld FC, Hazes JM (1994) Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Ann Rheum Dis 53(12):803–806PubMedCrossRefGoogle Scholar
  21. 21.
    Harrison MJ, Tricker KJ, Davies L, Hassell A, Dawes P, Scott DL, Knight S, Davis M, Mulherin D, Symmons DP (2005) The relationship between social deprivation, disease outcome measures, and response to treatment in patients with stable, long-standing rheumatoid arthritis. J Rheumatol 32(12):2330–2336PubMedGoogle Scholar
  22. 22.
    Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH (2005) A comparison of generic. Indirect utility measures (the HUI2. HUI3. SF-6D. and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 60:1571–1582PubMedCrossRefGoogle Scholar
  23. 23.
    El-Tantawy AM, El-Sayed AE, Kora BA, Amin RT (2008) Psychiatric morbidity associated with some cytokines (IL-1beta, IL-12, IL-18 and TNF-alpha) among rheumatoid arthritis patients. Egypt J Immunol 15(1):1–11PubMedGoogle Scholar
  24. 24.
    Abdelmoula L, Tekaya R, Ben Hadj Yahia C, Chaabouni L, Zouari R (2008) Morbidity of the elderly in inpatient rheumatology clinic. Tunis Med 86(4):350–354PubMedGoogle Scholar
  25. 25.
    El-Miedany Y, Youssef S, el-Gaafary M, Ahmed I (2003) Evaluating changes in health status: sensitivity to change of the modified Arabic Health Assessment Questionnaire in patients with rheumatoid arthritis. Jt Bone Spine 70(6):509–514CrossRefGoogle Scholar
  26. 26.
    Mathew AJ, Antony J, Eremenco S, Paul BV, Jayakumar B, Philip J (2009) Health-related quality of life in rheumatoid arthritis patients in South India. Singapore Med J 50(8):800–803PubMedGoogle Scholar
  27. 27.
    Ibn Yacoub Y, Amine B, Laatiris A, Wafki F, Znat F, Hajjaj-Hassouni N (2011) Fatigue and severity of rheumatoid arthritis in Moroccan patients. Rheumatol Int 32(7):1901–1907PubMedCrossRefGoogle Scholar
  28. 28.
    Thyberg I, Skogh T, Hass UA, Gerdle B (2005) Recent-onset rheumatoid arthritis: a 1-year observational study of correlations between health-related quality of life and clinical/laboratory data. J Rehabil Med 37:159–165PubMedGoogle Scholar
  29. 29.
    Garip Y, Eser F, Bodur H (2010) Health-related quality of life in rheumatoid arthritis: comparison of RAQoL with other scales in terms of disease activity, severity of pain, and functional status. Rheumatol Int 31(6):769–772PubMedCrossRefGoogle Scholar
  30. 30.
    Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Arkela-Kautiainen M, Sokka T (2005) Pain and joint mobility explain individual subdimensions of the health assessment questionnaire (HAQ) disability index in patients with rheumatoid arthritis. Ann Rheum Dis 64(1):59–63PubMedCrossRefGoogle Scholar
  31. 31.
    Perruccio AV, Power JD, Badley EM (2005) Arthritis onset and worsening self-rated health: a longitudinal evaluation of the role of pain and activity limitations. Arthritis Rheum 53:571–577PubMedCrossRefGoogle Scholar
  32. 32.
    Björk M, Gerdle B, Thyberg I, Peolsson M (2008) Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis—cross sectional and five year longitudinal analyses (the Swedish TIRA project). Disabil Rehabil 30(19):1429–1438PubMedCrossRefGoogle Scholar
  33. 33.
    Prajs K, Flicinski J, Brzosko I, Przepiera-Bedzak H, Ostane kL, Brzosko M (2006) Quality of life and activity of disease in patients with rheumatoid arthritis. Ann Acad Med Stetin 52:39–43PubMedGoogle Scholar
  34. 34.
    Van der Helm-van Mil AH, Verpoort KN, Breedveld FC, Toes RE, Huizinga TW (2005) Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid arthritis. Arthritis Res Ther 7(5):R949–R958PubMedCrossRefGoogle Scholar
  35. 35.
    Vittecoq O, Lequerré T, Goëb V, Le Loët X, Abdesselam TA, Klemmer N (2008) Smoking and inflammatory diseases. Best Pract Res Clin Rheumatol 22(5):923–935PubMedCrossRefGoogle Scholar
  36. 36.
    Mikuls TR, Hughes LB, Westfall AO, Holers VM, Parrish L, van der Heijde D, van Everdingen M, Alarcón GS, Conn DL, Jonas B, Callahan LF, Smith EA, Gilkeson G, Howard G, Moreland LW, Bridges SL Jr (2008) Cigarette smoking, disease severity and autoantibody expression in African Americans with recent-onset rheumatoid arthritis. Ann Rheum Dis 67(11):1529–1534PubMedCrossRefGoogle Scholar
  37. 37.
    Sokka T, Hannonen P (1999) Utility of disease modifying antirheumatic drugs in “sawtooth” strategy. A prospective study of early rheumatoid arthritis patients up to 15 years. Ann Rheum Dis 58(10):618–622PubMedCrossRefGoogle Scholar
  38. 38.
    Emery P, Kosinski M, Li T, Martin M, Williams GR, Becker JC, Blaisdell B, Ware JE Jr, Birbara C, Russell AS (2006) Treatment of rheumatoid arthritis patients with abatacept and methotrexate significantly improved health-related quality of life. J Rheumatol 33(4):681–689PubMedGoogle Scholar
  39. 39.
    Westhovens R, Cole JC, Li T, Martin M, Maclean R, Lin P, Blaisdell B, Wallenstein GV, Aranda R, Sherrer Y (2006) Improved health-related quality of life for rheumatoid arthritis patients treated with abatacept who have inadequate response to anti-TNF therapy in a double-blind, placebo-controlled, multicentre randomized clinical trial. Rheumatol (Oxford) 45(10):1238–1246CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Yousra Ibn Yacoub
    • 1
    • 2
    Email author
  • Bouchra Amine
    • 1
    • 2
  • Assia Laatiris
    • 1
    • 2
  • Najia Hajjaj-Hassouni
    • 1
    • 2
  1. 1.Department of Rheumatology (Pr N. Hajjaj-Hassouni), El Ayachi HospitalUniversity Hospital of Rabat-SaleSaleMorocco
  2. 2.Department of RheumatologyEl Ayachi HospitalSaleMorocco

Personalised recommendations