Coping with arthritis is experienced as a dynamic balancing process. A qualitative study

Clinical Rheumatology volume 30, Article number: 1425 (2011) Cite this article

Abstract

The aim of this study was to investigate the process of coping in people living with chronic inflammatory arthritis. Semi-structured individual face-to-face interviews with 26 persons having rheumatoid arthritis, psoriatic arthritis or unspecified polyarthritis were performed. The informants were asked how they experienced to live with arthritis and how they coped with challenges due to the arthritis. The main finding was that the informants experienced the process of coping with arthritis as a dynamic, iterative, balancing process. They balanced between different states, entitled “go on as usual”, “listen to the body”, “adjustments” and “attitude towards life”. The informants preferred to be in a “go on as usual” state as this was seen as normal life. However, disease fluctuations with pain, fatigue and stiffness disturbed the balance and made the informants “listen to the body”, a state where they became aware of how the disease affected them, followed by the “adjustment” state. Adjustments were composed of different efforts to ease the arthritis influence and for regaining balance. The “attitude towards life” influenced the overall process of coping. A redefined view of what the informants considered to be normal life thus happened through longer periods of imbalance. The process of coping with arthritis was found to be a dynamic, iterative, balancing process where patients redefined what they considered as normal life through the course of the disease.

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References

  1. 1.

    Zink A, Thiele K, Huscher D, Listing J, Sieper J, Krause A et al (2006) Healthcare and burden of disease in psoriatic arthritis. A comparison with rheumatoid arthritis and ankylosing spondylitis. J Rheumatol 33:86–90

    PubMed  Google Scholar 

  2. 2.

    Akil M, Amos RS (1995) ABC of rheumatology. Rheumatoid arthritis–I: clinical features and diagnosis. BMJ 310:587–590

    PubMed  CAS  Google Scholar 

  3. 3.

    Gladman DD (2004) Psoriatic arthritis. Dermatol Ther 17:350–363

    PubMed  Article  Google Scholar 

  4. 4.

    Uhlig T, Heiberg T, Mowinckel P, Kvien TK (2008) Rheumatoid arthritis is milder in the new millennium: health status in patients with rheumatoid arthritis 1994–2004. Ann Rheum Dis 67:1710–1715. doi:10.1136/ard.2007.084673

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Husted JA, Gladman DD, Farewell VT, Cook RJ (2001) Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis. Arthritis Rheum 45:151–158

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Arne M, Janson C, Janson S, Boman G, Lindqvist U, Berne C et al (2009) Physical activity and quality of life in subjects with chronic disease: chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus. Scand J Prim Health Care 27:141–147. doi:10.1080/02813430902808643

    PubMed  Article  Google Scholar 

  7. 7.

    Coty MB, Wallston KA (2008) Roles and well-being among healthy women and women with rheumatoid arthritis. J Adv Nurs 63:189–198. doi:10.1111/j.13652648.2008.04661.x

    PubMed  Article  Google Scholar 

  8. 8.

    Zyrianova Y, Kelly BD, Sheehan J, McCarthy C, Dinan TG (2010) The psychological impact of arthritis: the effects of illness perception and coping. Ir J Med Sci. doi:10.1007/s11845-010-0522-2

  9. 9.

    Lempp H, Scott D, Kingsley G (2006) The personal impact of rheumatoid arthritis on patients' identity: a qualitative study. Chronic Illn 2:109–120. doi:10.1177/17423953060020020601

    PubMed  Google Scholar 

  10. 10.

    Lazarus RS, Folkman S (1984) Stress, appraisal and coping. Springer, New York

    Google Scholar 

  11. 11.

    Lazarus RS (1993) Coping theory and research: past, present, and future. Psychosom Med 55:234–247

    PubMed  CAS  Google Scholar 

  12. 12.

    Albano MG, Giraudet-Le Quintrec JS, Crozet C, d'Ivernois JF (2010) Characteristics and development of therapeutic patient education in rheumatoid arthritis: analysis of the 2003–2008 literature. Joint Bone Spine 77:405–410

    PubMed  Article  Google Scholar 

  13. 13.

    Treharne GJ, Lyons AC, Hale ED, Goodchild CE, Booth DA, Kitas GD (2008) Predictors of fatigue over 1 year among people with rheumatoid arthritis. Psychol Health Med 13:494–504

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Aujoulat I, Marcolongo R, Bonadiman L, Deccache A (2008) Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control. Soc Sci Med 66:1228–1239. doi:10.1016/j.socscimed.2007.11.03415

    PubMed  Article  Google Scholar 

  15. 15.

    Stamm T, Lovelock L, Stew G, Nell V, Smolen J, Jonsson H et al (2008) I have mastered the challenge of living with a chronic disease: life stories of people with rheumatoid arthritis. Qual Health Res 18:658–669. doi:10.1177/1049732308316348

    PubMed  Article  Google Scholar 

  16. 16.

    Kralik D (2004) Chronic illness self-management: taking action to create order. J Clin Nurs 13:259–267

    PubMed  Article  Google Scholar 

  17. 17.

    Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 48:177–187

    PubMed  Article  Google Scholar 

  18. 18.

    Sinclair VG, Blackburn DS (2008) Adaptive coping with rheumatoid arthritis: the transforming nature of response shift. Chronic Illn 4:219–230. doi:10.1177/1742395308095356

    PubMed  Article  Google Scholar 

  19. 19.

    Iversen MD, Hammond A, Betteridge N (2010) Self-management of rheumatic diseases: state of the art and future perspectives. Ann Rheum Dis 69:955–963. doi:10.1136/ard.2010.129270

    PubMed  Article  Google Scholar 

  20. 20.

    Makelainen P, Vehvilainen-Julkunen K, Pietila AM (2009) Rheumatoid arthritis patient education: RA patients' experience. J Clin Nurs 18:2058–2065

    PubMed  Article  Google Scholar 

  21. 21.

    Kvale S (1996) Interviews: an introduction to qualitative research interviewing. Sage, Thousand Oaks

    Google Scholar 

  22. 22.

    Hammond A, Bryan J, Hardy A (2008) Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 47:1712–1718

    Article  CAS  Google Scholar 

  23. 23.

    Malterud K (1993) Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract 10:201–206

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Malterud K (2001) Qualitative research: standards, challenges, and guidelines. Lancet 358:483–488

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    QSR I (2007) NVIVO 8. QSR International Pty Ltd

  26. 26.

    Sanderson T, Morris M, Calnan M, Richards P, Hewlett S (2010) ‘It's this whole picture, this well-being’: patients' understanding of ‘feeling well’ with rheumatoid arthritis. Chronic Illn 6:228–240. doi:10.1177/1742395310377672

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Ostlie IL, Johansson I, Moller A (2009) Struggle and adjustment to an insecure everyday life and an unpredictable life course. Disabil Rehabil 31:666–674. doi:10.1080/09638280802305986

    PubMed  Article  Google Scholar 

  28. 28.

    Mengshoel AM (2008) Living with a fluctuating illness of ankylosing spondylitis: a qualitative study. Arthritis Rheum 59:1439–1444. doi:10.1002/art.24103

    PubMed  Article  Google Scholar 

  29. 29.

    Ahlmen M, Nordenskiold U, Archenholtz B, Thyberg I, Ronnqvist R, Linden L et al (2005) Rheumatology outcomes: the patient's perspective. A multicentre focus group interview study of Swedish rheumatoid arthritis patients. Rheumatology (Oxford) 44:105–110. doi:10.1093/rheumatology/keh412

    Article  CAS  Google Scholar 

  30. 30.

    Sanderson T, Morris M, Calnan M, Richards P, Hewlett S (2010) What outcomes from pharmacologic treatments are important to people with rheumatoid arthritis? Creating the basis of a patient core set. Arthritis Care Res (Hoboken) 62:640–646. doi:10.1002/acr.20034

    Article  CAS  Google Scholar 

  31. 31.

    Barlow JH, Turner AP, Wright CC (1998) Long-term outcomes of an arthritis self management programme. Br J Rheumatol 37:1315–1319

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Barlow JH, Turner AP, Wright CC (2000) A randomized controlled study of the Arthritis Self-Management Programme in the UK. Health Educ Res 15:665–680

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Townsend A (2006) Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness. Chronic Illn 2:185–194. doi:10.1177/17423953060020031301

    PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank the informants who participated in this study.

Funding

This work was supported by a research grant from The Research Council of Norway.

Disclosures

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Affiliations

  1. Department of Public Health and General Practice, Norwegian University of Science and Technology, MTFS, 7489, Trondheim, Norway

    Kjersti Grønning, Borghild Lomundal & Aslak Steinsbekk

  2. Department of Rheumatology, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway

    Kjersti Grønning & Hege Svean Koksvik

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  1. Kjersti Grønning
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  2. Borghild Lomundal
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  3. Hege Svean Koksvik
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  4. Aslak Steinsbekk
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Correspondence to Kjersti Grønning.

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Grønning, K., Lomundal, B., Koksvik, H.S. et al. Coping with arthritis is experienced as a dynamic balancing process. A qualitative study. Clin Rheumatol 30, 1425 (2011). https://doi.org/10.1007/s10067-011-1836-9

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Keywords

  • Arthritis
  • Coping
  • Patient perspective
  • Qualitative study
  • Self management