Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul 133-792, South Korea.
Rheumatol Int. 2013 Jan;33(1):93-102. doi: 10.1007/s00296-011-2352-6. Epub 2012 Jan 5.
The aim of the study was to identify factors influencing the health-related quality of life (HR-QOL) for Korean RA patients and factors associated with each dimension of the EQ-5D. Two hundred and twenty-five RA patients were recruited from one University Hospital in Seoul, South Korea. Their clinical and socio-demographic data were widely collected by means of interviews, self-administered questionnaires, and clinical examinations. Multiple logistic regression analyses were performed to determine the factors influencing QOL and factors associated with each dimension of the EQ-5D. The mean EQ-5D utility observed for Korean RA patients was 0.60 (-0.29 to 1.0). Functional disability measured with Health Assessment Questionnaire (OR = 10.0, CI 2.8-34.5), disease activity score (DAS) 28 (OR = 2.6, CI 1.4-4.9), and pain VAS (OR = 2.2, CI 1.2-4.1) was three main factors influencing on QOL of RA patients. Although the functional disability consistently showed significant associations with all dimensions, various factors were associated with the each five specific dimension of EQ-5D. Pain (OR = 2.5, CI 1.4-4.6), history of hospitalization (OR = 2.1, CI 1.0-4.3), and men (OR = 2.6, CI 1.0-6.8) were associated with lower QOL in mobility. Use of alternative medicine (OR = 2.0, CI 1.1-3.7) and disease activity (OR = 3.1, CI 1.7-5.7) were associated with lower self-care QOL. For the patients with discomfort in usual activity, pain (OR = 4.7, CI 2.4-9.2) and the presence of anemia (OR = 2.3, CI 1.2-4.5) were major influencing factors. Higher disease activity (OR = 4.5, CI 1.0-21.2) and pain (OR = 3.3, CI 1.9-5.8) were associated with the pain/discomfort dimension of EQ-5D, and the pain (OR = 3.3, CI 1.9-5.8) was an independent associating factor of anxiety/depression. The strongest determinants of lower QOL in Korean RA patients were functional disability, higher disease activity, and subjective pain. However, various factors are influencing on the QOL for RA patients according to aspects of QOL. It suggested that clinicians should pay more attention to other factors of RA patients as well as clinical remission to improve their QOL.
本研究旨在确定影响韩国类风湿关节炎（RA）患者健康相关生活质量（HR-QOL）的因素，以及与 EQ-5D 各维度相关的因素。我们从韩国首尔的一家大学医院招募了 225 名 RA 患者。通过访谈、自我管理问卷和临床检查广泛收集了他们的临床和社会人口统计学数据。采用多因素逻辑回归分析确定影响 QOL 的因素以及与 EQ-5D 各维度相关的因素。韩国 RA 患者的平均 EQ-5D 效用值为 0.60（-0.29 至 1.0）。功能障碍（健康评估问卷[OR] = 10.0，CI 2.8-34.5）、疾病活动评分（DAS）28（OR = 2.6，CI 1.4-4.9）和疼痛视觉模拟量表（VAS）（OR = 2.2，CI 1.2-4.1）是影响 RA 患者 QOL 的三个主要因素。尽管功能障碍与所有维度均呈显著相关，但各种因素与 EQ-5D 的五个特定维度相关。疼痛（OR = 2.5，CI 1.4-4.6）、住院史（OR = 2.1，CI 1.0-4.3）和男性（OR = 2.6，CI 1.0-6.8）与移动能力下降相关。使用替代药物（OR = 2.0，CI 1.1-3.7）和疾病活动（OR = 3.1，CI 1.7-5.7）与自我护理 QOL 下降相关。对于通常活动不适的患者，疼痛（OR = 4.7，CI 2.4-9.2）和贫血（OR = 2.3，CI 1.2-4.5）是主要影响因素。更高的疾病活动（OR = 4.5，CI 1.0-21.2）和疼痛（OR = 3.3，CI 1.9-5.8）与 EQ-5D 的疼痛/不适维度相关，疼痛（OR = 3.3，CI 1.9-5.8）是焦虑/抑郁的独立相关因素。功能性残疾、较高的疾病活动和主观疼痛是影响韩国 RA 患者 QOL 的最强决定因素。然而，根据 QOL 方面，各种因素也会影响 RA 患者的 QOL。这表明临床医生除了关注临床缓解外，还应更加关注 RA 患者的其他因素，以提高他们的 QOL。
