Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.
Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
Semin Arthritis Rheum. 2022 Aug;55:152014. doi: 10.1016/j.semarthrit.2022.152014. Epub 2022 Apr 21.
Rheumatoid arthritis (RA) considerably impacts patients' mental health. However, it is largely unclear how people suffering from RA experience psychological stress beyond depression or anxiety, and what drives stress in these patients.
To examine the impact of RA on psychological stress, as follows: 1) How is stress defined and described in studies on RA? 2) Do patients with RA experience more stress than the general population or people suffering from other chronic conditions? 3) What are risk factors for developing stress in this context?
We systematically searched EMBASE, PubMed, Web of Science Core Collection and Cochrane Library for English language peer-reviewed reports published up to 19 April 2020. Eligible studies included any measure or definition of psychological stress as an outcome in patients with RA. Data were extracted on patient and study characteristics, instruments used to measure stress and predictors of stress, and were summarized descriptively. Study quality was assessed with the MINORS or AXIS-tool for longitudinal and cross-sectional studies, respectively.
Among 11.115 potentially relevant studies, 16 studies were included. Remarkably, 13 different instruments to measure stress were reported in these studies. Different types of stress experienced by patients with RA included role stress, social stress, and work stress. Work stress and social stress, particularly resulting from interpersonal stressors, were reported as more prevalent in patients with RA compared to healthy controls. Stress at disease onset appeared more pronounced in patients with RA compared to people suffering from osteoarthritis, while psychological stress was reported as higher in patients with chronic pain syndromes compared to patients with RA. More disability, more pain, less social support, lower income, younger age and personality traits like excessive worrying, pessimism, and sensitivity to anxiety, seemed to increase the risk for higher stress levels.
This scoping review is, to our knowledge, the first to address the important heterogeneity of the measurement tools and definitions of psychological stress in RA research. This review could provide a basis to standardize the concept of stress in people suffering from RA, with a view to proposing tailored stress-reducing interventions.
类风湿关节炎（RA）严重影响患者的心理健康。然而，人们对 RA 患者除抑郁或焦虑之外的心理压力体验，以及哪些因素导致这些患者产生压力，仍知之甚少。
本研究旨在探讨 RA 对心理压力的影响，具体内容如下：1）在 RA 研究中，压力是如何定义和描述的？2）RA 患者的压力是否比一般人群或患有其他慢性疾病的人群更大？3）在这种情况下，导致压力产生的风险因素有哪些？
我们系统地检索了 EMBASE、PubMed、Web of Science 核心合集和 Cochrane Library 中截至 2020 年 4 月 19 日发表的英文同行评议报告。纳入标准为：任何将心理压力作为 RA 患者结局的测量或定义的研究。提取患者和研究特征、用于测量压力的工具以及压力预测因素等数据，并进行描述性总结。使用 MINORS 或 AXIS 工具分别对纵向和横断面研究进行质量评估。
在 11115 篇潜在相关研究中，有 16 篇研究被纳入。值得注意的是，这些研究报告了 13 种不同的压力测量工具。RA 患者经历的不同类型的压力包括角色压力、社会压力和工作压力。与健康对照组相比，RA 患者报告的工作压力和社会压力，尤其是人际压力源导致的工作压力和社会压力更为普遍。与骨关节炎患者相比，RA 患者疾病发作时的压力更为明显，而与 RA 患者相比，慢性疼痛综合征患者的心理压力更高。更多的残疾、更多的疼痛、更少的社会支持、更低的收入、更年轻的年龄以及过度担忧、悲观和对焦虑敏感等个性特征似乎增加了更高压力水平的风险。
本综述是我们所知的首次针对 RA 研究中心理压力的测量工具和定义的重要异质性进行的研究。该综述可以为 RA 患者的压力概念标准化提供依据，以期提出有针对性的减压干预措施。
