Summary
Despite the rather pessimistic outlook regarding the long term effects of pharmacological treatment of patients with rheumatoid arthritis (RA), there is no doubt that drug interventions can affect quality of life (QOL). The disease has a significant impact upon physical, psychological and social function, and QOL optimisation should cover all these dimensions.
Swelling of joints and pain are important manifestations in assessing RA since these may result in sleep disturbances as well as depressed mood. This might be particularly significant for older persons with RA.
Outcome parameters of RA can be divided into short, intermediate and long term. The long term results are quite disappointing with regard to disability and premature death. However, more intermediate outcome measures related to QOL might improve after pharmacological interventions. Patient preferences and expectations with regard to the outcome of pharmacological interventions are important parameters to assess.
When assessing older patients with RA with QOL instruments, it is recommended that questionnaires are fairly short and easy to complete. Adverse effects of pharmacological interventions are important factors to monitor in QOL assessment in older patients with reduced remaining life span.
Similar content being viewed by others
References
Anderson KO, Bradley LA, Young LD, et al. Rheumatoid arthritis: review of psychological factors related to etiology, effects and treatment. Psychol Bull 1985; 98: 358–87
Gran JT. The epidemiology of rheumatoid arthritis. Monogr Allergy 1987; 14 Suppl. 15: 162–96
Mitchell DM, Spitz PW, Young DY, et al. Survival, prognosis and causes of death in rheumatoid arthritis. Arthritis Rheum 1986; 29: 706–14
Pincus T, Callahan LF. Reassessment of twelve traditional paradigms concerning the diagnosis, prevalence, morbidity and mortality of rheumatoid arthritis. Scand J Rheumatol 1989; 18: 67–96
Ehrlich GE. Social, economic, psychological, and sexual outcomes in rheumatoid arthritis. Am J Med 1983; 30: 27–34
Revenson TA, Felton BJ. Disability and coping as predictors of psychological adjustment to rheumatoid arthritis. J Consult Clin Psychol 1989; 57: 344–8
Aaronson NK. Quality of life: what is it? How should it be measured? Oncology 1988; 2: 69–74
Bell MJ, Bombardier C, Tugwell P. Measurement of functional status, quality of life, and utility in rheumatoid arthritis. Arthritis Rheum 1990; 33: 591–600
World Health Organization. The first ten years of the World Health Organization. Geneva: WHO, 1958
Bendtsen P. Rheumatoid arthritis. Patient perception of disease, care, quality of life, coping and well-being [dissertation]. Linköping, Sweden: University of Linköping 1994; 148
Spector TD, Scott DL. What happens to patients with rheumatoid arthritis? The long-term outcome of treatment. Clin Rheumatol 1988; 7: 315–30
Bombardier C. The optimal use of cyclosporin A in rheumatoid arthritis: efficacy and outcome measuring including quality of life. J Rheumatol 1993; 32 Suppl. 1: 47–50
Wolfe F. 50 years of anti-rheumatic therapy: the prognosis of rheumatoid arthritis. J Rheumatol 1990; 17 Suppl. 22: 24–32
Spector TD. Epidemiological aspects of studying outcome in rheumatoid arthritis. Br J Rheumatol 1988; 27 Suppl. 1: 5–11
Ferraz MB, Quaresma MR, Goldsmith CH, et al. Corticosteroids in patients with rheumatoid arthritis: utility measurements for evaluating risks and benefits. Rev Rhum English Ed 1994; 61: 240–4
Wright V. Measurement of outcome in rheumatic diseases. J R Soc Med 1985; 78: 985–94
Liang MH, Cullen KE, Larson MG. Measuring function and health status in rheumatic disease clinical trials. Clin Rheum Dis 1983; 9: 531–9
Borg G, Allander E, Berg E, et al. Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from 2-year double blind trial. J Rheumatol 1991; 18: 1015–20
Anderson KO, Keefe KJ, Bradley LA, et al. Prediction of pain behavior and functional status of rheumatoid arthritis patients using medical status and psychological variables. Pain 1988; 33: 25–32
Keefe FJ, Brown GK, Wallston KA, et al. Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy. Pain 1989; 37: 51–6
Wolfe F, Hawley DJ, Cathey MA. Clinical and health status measures over time: prognosis and outcome measurements in rheumatoid arthritis. J Rheumatol 1991; 18: 1290–7
Bendtsen P, Hörnquist JO. Severity of rheumatoid arthritis, function and quality of life: sub-group comparisons. Clin Exp Rheumatol 1993; 11: 495–502
Bendtsen P, Bjurulf P, Trell E, et al. Treatment perspectives in rheumatoid arthritis. A descriptive study in a Swedish health care district. PharmacoEconomics 1994; 5: 399–407
Hunt SM, McKenna SP, McEwen J, et al. The Nottingham health profile subjective health status and medical consultations. Soc Sci Med 1981; 15A: 221–9
Bendtsen P, Åkerlind I, Hörnquist JO. Assessment of quality of life in rheumatoid arthritis. PharmacoEconomics 1994; 5: 286–98
Mason JH, Weener JL, Gertmna PM, et al. Health status in chronic disease: a comparative study of rheumatoid arthritis. J Rheumatol 1983; 10: 763–8
Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions. JAMA 1989; 262: 907–13
Bendtsen P, Hörnquist JO. Change and status in quality of life in patients with rheumatoid arthritis. Qual Life Res 1992; 1: 297–305
Borstlap M, van de Laar M, van der Korst J. Components of health: an analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables. Ann Rheum Dis 1993; 52: 650–4
Bijlsma JWJ, Huiskes CTAE, Kraaimaat FW, et al. Relation between patients own health assessment and clinical and laboratory findings in rheumatoid arthritis. J Rheumatol 1991; 18: 650–3
Wolfe F, Pincus T. Standard self-report questionnaires in routine clinical and research practice. An opportunity for patients and rheumatologists [editorial]. J Rheumatol 1991; 18: 643–5
Bellamy N. Prognosis in rheumatoid arthritis [editorial]. J Rheumatol 1991; 18: 1277–9
James MA, Potter JF. The effect of antihypertensive treatment on the quality of later years. Drugs Aging 1993; 3: 26–39
Wegener ST. Cognitive, behavioral and psychological issues in the rheumatological care of elderly. Scand J Rheumatol 1989; Suppl. 82: 39–49
Bendtsen P, Bjurulf P, Trell E, et al. Cross-sectional assessment and subgroup comparison of functional disability in patients with rheumatoid arthritis in a Swedish health-care district. Disabil Rehabil 1994; 17: 94–9
Tugwell P, Bombardier C. A methodological framework for developing and selecting endpoints in clinical trials. J Rheumatol 1982; 9: 758–62
Long AE, Scott DL. Measuring health status and outcomes in rheumatoid arthritis within routine clinical practice. Br J Rheumatol 1994; 33: 682–5
Jensen E, Dehlin O, Hagberg B, et al. Medical, psychological, and sociological aspects of drug treatment in 80-year-olds. Z Gerontol 1994; 27: 140–4
Terkeltaub R, Esdaile J, Décary F, et al. A clinical study of older age rheumatoid arthritis with comparison to a younger onset group. J Rheumatol 1983; 10: 418–24
Mutru O, Laakso M, Isomäki H, et al. Ten years mortality and causes of death in patients with rheumatoid arthritis. BMJ 1985; 290: 1797–9
Fries JF, Spitz PW, Mitchell DM, et al. Impact of specific therapy upon rheumatoid arthritis. Arthritis Rheum 1986; 29: 620–7
Liang MH. Compliance and quality of life: confession of a difficult patient. Arthritis Care Res 1989; 2: 71–4
Tugwell P, Bombardier C, Buchanan WW, et al. The MACTAR patient preference disability questionnaire. An individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol 1987; 14: 446–51
Buckelew SP, Parker JC. Coping with arthritis pain. Arthritis Care Res 1989; 2: 136–45
Young LD. Psychological factors in rheumatoid arthritis. J Consult Clin Psychol 1992; 60: 619–27
van Lankveld W, Näring G, van der Staak C, et al. Stress caused by rheumatoid arthritis: relation among subjective Stressors of the disease, disease status and well-being. J Behav Med 1993; 16: 309–21
Hurst NP, Jobanputra P, Hunter M, et al. Validity of EUROQOL — a generic health status instrument — in patients with rheumatoid arthritis. Br J Rheumatol 1994; 33: 655–62
Parker J, McRae C, Smarr K, et al. Coping strategies in rheumatoid arthritis. J Rheumatol 1988; 15: 1376–83
Reisine ST, Grady KE, Goodenow C, et al. Work disability among women with rheumatoid arthritis. Arthritis Rheum 1989; 32: 538–43
Fritzpatrick R, Newman S, Lamb R, et al. Social relationship and psychological well-being in rheumatoid arthritis. Soc Sci Med 1988; 27: 399–403
Lambert VA, Lambert CE, Klipple GL, et al. Social support, hardiness and psychological well-being in women with arthritis. J Nurs Scholarship 1989; 21: 128–31
Smith CA, Waalston KA. Adaptation in patients with chronic rheumatoid arthritis: application of a general model. Health Psychol 1992; 11: 151–62
Krol B, Sanderman R, Suurmeijer T, et al. Disease characteristics, level of self-esteem and psychological well-being in rheumatoid arthritis. Scand J Rheumatol 1994; 23: 8–12
Potts M, Weinberger M, Brandt KD. Views of patients and providers regarding the importance of various aspects of an arthritis treatment program. J Rheumatol 1984; 11: 71–5
Tugwell P, Bombardier C, Buchanan WW, et al. Methotrexate in rheumatoid arthritis. Arch Intern Med 1990; 150: 59–62
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bendtsen, P., Åkerlind, I. & HÖrnquist, JO. Pharmacological Intervention in Older Patients with Rheumatoid Arthritis. Drugs & Aging 7, 338–346 (1995). https://doi.org/10.2165/00002512-199507050-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-199507050-00002