Department of Rheumatology, El Ayachi Hospital, University Hospital of Rabat-Sale, Morocco.
Health Qual Life Outcomes. 2011 Aug 1;9:58. doi: 10.1186/1477-7525-9-58.
To evaluate the impact of spinsterhood on disease characteristics and quality of life (QoL) in Moroccan women with rheumatoid arthritis (RA).
185 women with RA were recruited in this study. Marital status was specified as follow: 1. Spinsterhood (never-married woman aged 38 or over), 2. Distressed marriage; 3. Nondistressed marriage and 4. Divorced or widowed. Marital distress was assessed by a self-report concerning coping efficacy and burden caring of husbands. Assessment criteria included the evaluation of: age at onset (years), diagnosis delay (months), disease duration (years), disease activity (evaluated by physical examination, biological inflammatory tests; and disease activity score (DAS 28)), pain intensity (measured with a visual analogue scale (VAS)); and radiographic damage (evaluated by the Sharp's method as modified by van der Heijde). Treatments (doses and duration) were specified. The Health Assessment Questionnaire (HAQ) was used to evaluate functional disability. QoL was measured using the Arabic version of the generic instrument SF-36.
In our data, spinsterhood was detected in 42 (22.7%) patients vs. 88 (47.5%) with distressed marriage, 28 (15.1%) with nondistressed marriage and 27 (14.6%) divorced or widowed. Comparing the 4 groups, we found that QoL in never-married women was damaged in a significant way comparing to the other groups. Mental as well as physical aspects were affected. Also, we found that spinsterhood was associated to an early age at onset (p = 0.009), pain intensity (p < 0.001); clinical (p < 0.001) and biological disease activity (C-reactive protein; p = 0.02) and functional disability (p < 0.001). Logistic regression analysis revealed a significant relationship between spinsterhood and early age at onset and severe functional disability (for all p ≤ 0.01).
This study suggests that spinsterhood in our RA patients was associated with an altered QoL even compared with distressed married women. Also, we state that spinsterhood was associated with an early age at onset, severe joint pain; higher disease activity and with altered functional ability. It seems important to consider not only disease-related parameters but also social status as a determinant factor of poor course in RA.
评估单身状态对摩洛哥类风湿关节炎（RA）女性疾病特征和生活质量（QoL）的影响。
本研究共纳入 185 名 RA 女性患者。婚姻状况具体分为以下几种：1. 单身（38 岁及以上未婚女性）；2. 不幸婚姻；3. 幸福婚姻；4. 离婚或丧偶。婚姻不幸通过自评来评估，涉及配偶的应对效能和照顾负担。评估标准包括：发病年龄（岁）、诊断延迟（月）、疾病持续时间（年）、疾病活动度（通过体格检查、生物炎症检测、疾病活动评分（DAS 28）评估）、疼痛强度（用视觉模拟量表（VAS）测量）和放射学损伤（用 van der Heijde 改良的 Sharp 方法评估）。还指定了治疗方法（剂量和持续时间）。采用健康评估问卷（HAQ）评估功能障碍。使用阿拉伯语版通用量表 SF-36 评估生活质量。
在我们的数据中，单身患者有 42 例（22.7%），不幸婚姻患者有 88 例（47.5%），幸福婚姻患者有 28 例（15.1%），离婚或丧偶患者有 27 例（14.6%）。与其他组相比，我们发现单身女性的生活质量明显受损，心理和身体方面都受到影响。此外，我们发现单身与发病年龄较早（p=0.009）、疼痛强度较大（p＜0.001）、临床疾病活动度较高（p＜0.001）、生物疾病活动度（C 反应蛋白；p=0.02）和功能障碍（p＜0.001）有关。Logistic 回归分析显示，单身与发病年龄较早和严重功能障碍之间存在显著关系（所有 p≤0.01）。
本研究表明，与不幸婚姻的女性相比，单身状态与我们 RA 患者的生活质量下降有关。此外，我们发现单身与发病年龄较早、严重关节疼痛、疾病活动度较高以及功能障碍有关。因此，考虑疾病相关参数和社会地位作为 RA 不良病程的决定因素非常重要。
