Purpose. To assess the degree of participation of the visually impaired elderly and to make a com... more Purpose. To assess the degree of participation of the visually impaired elderly and to make a comparison with populationbased reference data. Method. This cross-sectional study included visually impaired elderly persons (55 years; n ¼ 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions. Results. Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%). Conclusions. Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.
Part of our study, the Dutch Quality of Life and Quality of Care Investigation in Epilepsy (DUQQI... more Part of our study, the Dutch Quality of Life and Quality of Care Investigation in Epilepsy (DUQQIE), intended to cover several of the components of the quality of life (QoL) concept. To this end, a series of already existing generic and disease-specific instruments was selected covering several parts of the QoL components in order to construct a multidimensional ''QoL profile'' for people with epilepsy and to look for underlying second-order QoL dimensions. From the records of four outpatient clinics, 210 persons with epilepsy were randomly selected. During their visit to the outpatient clinic, they completed a questionnaire assessing, among others, health perceptions, psychological well-being, and social functioning. Additional information about their medical and psycho-social status was gathered from the patient files. A large part of our research group was not seizure-free. As far as comparisons with other patient or healthy groups could be made, it appeared that they mostly did not (much) worse and all scores were above the scale midpoint. However, almost two-thirds of the scale means lied below a so-called ''normative mean.'' Higher-order factor analysis yielded one general factor measuring the ''Overall Quality of Life.'' Furthermore, after rotation of this general factor, two separate factors could be constructed referring to the psychophysical and psycho-social aspects of QoL, respectively. We decided not to develop ''quality of life instrument'' de novo to the already vast and ever increasing area of QoL instruments, but to use already existing, mostly generic, and well-validated instruments. The most important advantage of this approach is that it allows for ''normative controls'' (norms; other groups) and ''conceptual modeling.'' The latter is that the QoL concept can be unfolded into its component parts and hypothetically related to each other.
The medical situation (seizure-free periods, use of medicine, medical supervision) of a group of ... more The medical situation (seizure-free periods, use of medicine, medical supervision) of a group of 136 epileptic children was investigated at the age of 11. One hundred and nine of these children were individually matched with 109 children without chronic illness and their educational achievements were compared. We came by these groups via their family doctors or their schools/teachers respectively. We followed-up their medical and educational situation 5 years later. In this way we have been able to establish long-term trends regarding the medical situation and the educational achievements of the children. From the data it appeared that between half and two-thirds of the children were seizure-free for 5 years or longer. One-quarter, however, seemed to be therapy resident and still had seizures. At the age of 16, four out of 10 children were no longer under the supervision of any health care provider; five out of 10 did not use antiepileptic drugs anymore; but 20% of them still had seizures. There was no evidence of such improvements in the educational careers of these children: their educational levels stayed behind those of the controls.
XIth International Congress on Thrombosis and Haemostasis, 1987
The 1ife-expectancy of hemophiliacs has risen during the last decades from (for severe hemophilia... more The 1ife-expectancy of hemophiliacs has risen during the last decades from (for severe hemophilia) a mere 16 yrs in 1940, 23 yrs in 1964 to almost normal after coagulation factor preparations became available. Still, many hemophiliacs encounter ratings or refusals when applying for life-insurance.We carried out three mail surveys (1972, 1978, 1985) among Dutch hemophiliacs to establish excess mortality caused by hemophilia. Follow-up for non-respondents was carried out with help from the municipal authorities, while information on the deceased was obtained from the hemophilia treatment centers. To compare mortality with the general population, we constructed Kaplan-Meier reference curves for population groups with the same age and sex distribution, using national death tables. Pending completion of the follow-up for the 1972-1985 interval, this abstract supplies the results for the 1978-1985 period.The 1978 cohort included 578 individuals, with a mean age of 26 yrs (general male pop...
Nederlands tijdschrift voor geneeskunde, Jan 25, 1989
The influence of modern substitution therapy on social functioning of haemophiliacs was studied b... more The influence of modern substitution therapy on social functioning of haemophiliacs was studied by means of surveys of education and employment in 1972, 1978 and 1985. In addition we studied the physical mobility of the patients. Non-attendance at school and educational delay decreased substantially over thirteen years and the educational level of adult patients is the same as that of the general male population. Sick leave decreased also but the number of disabled did not. Considering the general rise in the number of disabled, the general unemployment situation may be partly blamed for this. Younger patients have a better physical mobility than the older ones who did not have appropriate treatment of bleedings when they were young. Trends in reduction of joint impairment and increase of physical mobility are expected to continue in the coming decades, with a positive effect on social functioning.
Background There is clear epidemiological evidence for a relationship between social support and ... more Background There is clear epidemiological evidence for a relationship between social support and health. Though, the mechanism remains unclear whether a poor social support precedes or follows a poor health status. Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting particularly quality of life. Objectives First, to investigate cross-sectional relationships between quality of life and social support (SS) and support network (SN) in patients with early RA. Then to look at how baseline SS or SN influence quality of life over time; and last, to explore how variations over time in SS or SN affect quality of life over time. Methods Subjects were members of the EURIDISS population-based cohort from France, the Netherlands and Norway, and had suffered from RA for less than 5 years. Yearly assessments were made of SS, SN, psychological well-being (GHQ), and functional disability (HAQ). Variance and covariance analyses with repeated measures were calculated and adjusted for...
Patient compliance is considered necessary for the success of drug treatment in chronic diseases.... more Patient compliance is considered necessary for the success of drug treatment in chronic diseases. We document compliance with drug treatment and the factors affecting it in a cohort of patients with rheumatoid arthritis (RA). A prospective cohort study of 556 patients with RA followed for 3 years in 4 counties: Oslo, Norway; Groningen, The Netherlands; and Nancy and Reims, France. Compliance to treatment was assessed annually by interview in terms of adherence to the dose and timing of the prescribed drug regimen. Of the 556 subjects, 429 (77.2%) were taking medication for RA throughout the observation period. Consistent behavior was recorded in 59.5% of cases: 35.7% were consistently compliant, and 23.8% consistently noncompliant. Factors significantly associated with good compliance were older age (p = 0.00), female sex (p = 0.03), decreased disability (p = 0.04), very satisfactory contacts with health care professionals (p = 0.03), and more personal knowledge about the disease an...
To provide a description and identify risk factors for functional disability in early rheumatoid ... more To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. Consequences for the early management of RA ar...
OBJECTIVE To compare a disease specific measure of functional status, the Health Assessment Quest... more OBJECTIVE To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied. METHODS In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between T1 and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences. RESULTS The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are > 0.91 for ...
OBJECTIVE To delineate compliance with drug therapy in rheumatoid arthritis patients, determine s... more OBJECTIVE To delineate compliance with drug therapy in rheumatoid arthritis patients, determine specific characteristics of compliant and noncompliant patients, and look for changes in compliance over time. PATIENTS AND METHODS A prospective European cohort study (EURIDISS) recruited 556 patients in four countries over three years. Compliance with drug dosages and dosing times was evaluated yearly using a questionnaire. RESULTS Of the 556 patients, 429 (77.2%) were on drug therapy at all three evaluation time points. Use of steroids, nonsteroidal anti-inflammatory drugs, and second-line drugs varied significantly across countries. The compliance behavior was stable over time in 59.5% of them (35.7% of patients were consistently compliant and 23.8% consistently noncompliant); it was independent of disease duration and from the clinical features of the disease. Older patients and women were more likely to be compliant (odds ratios, 2.5 and 2, respectively). CONCLUSION Compliance with ...
XIth International Congress on Thrombosis and Haemostasis
Coagulation factor preparations became available in the treatment of hemophilia about twenty year... more Coagulation factor preparations became available in the treatment of hemophilia about twenty years ago, followed by the introduction of prophylactic therapy and home-treatment. The purpose of our longitudinal study was to quantify the impact of these treatment modalities on the medical and social situation of hemophiliacs.We carried out three mail surveys (1972, 1978 and 1985) among Dutch hemophiliacs. In 1985 we sent questionnaires to 1162 of the estimated total of 1300 patients with a response of 81%. Eighty-six percent of the respondents had hemophilia A, 14% hemophilia B; 41% had severe hemophilia (<1%) 19% moderately-severe (1-5%) and 40% mild hemophilia (>5%). Growth of prophylactic therapy and home-treatment for severe hemophilia was The mean age increased from 21 yrs in 1972 (n=435) to 29 yrs in 1985 (n=935)(general male population: 34 yrs). The number of manifest bleedings decreased from 25 in 1972 to 15 in 1985, with a corresponding decrease in the number of transfus...
Objective-To analyze how the patient himself perceives his physical and social situation 1 year a... more Objective-To analyze how the patient himself perceives his physical and social situation 1 year after Guillain-Barre´syndrome (GBS). Material and method-The Dutch patients who participated in an international multicenter trial were asked to complete a selfadministered questionnaire containing questions on their physical status at homecoming and at 12 months, as well as questions dealing with various aspects of their social condition. Results-Ninety patients participated. Up to 72% had sensory disturbances and loss of power in part of the arms and up to 89% in part of the legs at homecoming. At 12 months, a significant improvement had occurred, but residua were perceived in 36 and 67%, respectively. The residua ranged from irritating to seriously disturbing in up to 49%, and only 33% felt completely cured. Furthermore, 32% had changed their work due to GBS, 30% did not function at home as well as before and 52% had altered their leisure activities. Conclusion-One year after the onset of GBS, a considerable number of patients still perceived a decrease of power and sensation with an often disturbing effect. GBS had an evident impact on daily life and social well-being.
Arthritis care and research : the official journal of the Arthritis Health Professions Association, 1994
Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the ... more Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well-being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well-being. The focus of the present study is on the main effect versus the buffering effect of social support. Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home. Receiving more daily emotional support positively related to greater psychological well-being; whereas problem-oriented emotional support negatively related to some aspects of psychological well-being. People receiving more social companionship turned out to be less depressed. The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.
To provide a description and identify risk factors for functional disability in early rheumatoid ... more To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. Consequences for the early management of RA are underlined.
Purpose. To assess the degree of participation of the visually impaired elderly and to make a com... more Purpose. To assess the degree of participation of the visually impaired elderly and to make a comparison with populationbased reference data. Method. This cross-sectional study included visually impaired elderly persons (55 years; n ¼ 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions. Results. Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%). Conclusions. Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.
Part of our study, the Dutch Quality of Life and Quality of Care Investigation in Epilepsy (DUQQI... more Part of our study, the Dutch Quality of Life and Quality of Care Investigation in Epilepsy (DUQQIE), intended to cover several of the components of the quality of life (QoL) concept. To this end, a series of already existing generic and disease-specific instruments was selected covering several parts of the QoL components in order to construct a multidimensional ''QoL profile'' for people with epilepsy and to look for underlying second-order QoL dimensions. From the records of four outpatient clinics, 210 persons with epilepsy were randomly selected. During their visit to the outpatient clinic, they completed a questionnaire assessing, among others, health perceptions, psychological well-being, and social functioning. Additional information about their medical and psycho-social status was gathered from the patient files. A large part of our research group was not seizure-free. As far as comparisons with other patient or healthy groups could be made, it appeared that they mostly did not (much) worse and all scores were above the scale midpoint. However, almost two-thirds of the scale means lied below a so-called ''normative mean.'' Higher-order factor analysis yielded one general factor measuring the ''Overall Quality of Life.'' Furthermore, after rotation of this general factor, two separate factors could be constructed referring to the psychophysical and psycho-social aspects of QoL, respectively. We decided not to develop ''quality of life instrument'' de novo to the already vast and ever increasing area of QoL instruments, but to use already existing, mostly generic, and well-validated instruments. The most important advantage of this approach is that it allows for ''normative controls'' (norms; other groups) and ''conceptual modeling.'' The latter is that the QoL concept can be unfolded into its component parts and hypothetically related to each other.
The medical situation (seizure-free periods, use of medicine, medical supervision) of a group of ... more The medical situation (seizure-free periods, use of medicine, medical supervision) of a group of 136 epileptic children was investigated at the age of 11. One hundred and nine of these children were individually matched with 109 children without chronic illness and their educational achievements were compared. We came by these groups via their family doctors or their schools/teachers respectively. We followed-up their medical and educational situation 5 years later. In this way we have been able to establish long-term trends regarding the medical situation and the educational achievements of the children. From the data it appeared that between half and two-thirds of the children were seizure-free for 5 years or longer. One-quarter, however, seemed to be therapy resident and still had seizures. At the age of 16, four out of 10 children were no longer under the supervision of any health care provider; five out of 10 did not use antiepileptic drugs anymore; but 20% of them still had seizures. There was no evidence of such improvements in the educational careers of these children: their educational levels stayed behind those of the controls.
XIth International Congress on Thrombosis and Haemostasis, 1987
The 1ife-expectancy of hemophiliacs has risen during the last decades from (for severe hemophilia... more The 1ife-expectancy of hemophiliacs has risen during the last decades from (for severe hemophilia) a mere 16 yrs in 1940, 23 yrs in 1964 to almost normal after coagulation factor preparations became available. Still, many hemophiliacs encounter ratings or refusals when applying for life-insurance.We carried out three mail surveys (1972, 1978, 1985) among Dutch hemophiliacs to establish excess mortality caused by hemophilia. Follow-up for non-respondents was carried out with help from the municipal authorities, while information on the deceased was obtained from the hemophilia treatment centers. To compare mortality with the general population, we constructed Kaplan-Meier reference curves for population groups with the same age and sex distribution, using national death tables. Pending completion of the follow-up for the 1972-1985 interval, this abstract supplies the results for the 1978-1985 period.The 1978 cohort included 578 individuals, with a mean age of 26 yrs (general male pop...
Nederlands tijdschrift voor geneeskunde, Jan 25, 1989
The influence of modern substitution therapy on social functioning of haemophiliacs was studied b... more The influence of modern substitution therapy on social functioning of haemophiliacs was studied by means of surveys of education and employment in 1972, 1978 and 1985. In addition we studied the physical mobility of the patients. Non-attendance at school and educational delay decreased substantially over thirteen years and the educational level of adult patients is the same as that of the general male population. Sick leave decreased also but the number of disabled did not. Considering the general rise in the number of disabled, the general unemployment situation may be partly blamed for this. Younger patients have a better physical mobility than the older ones who did not have appropriate treatment of bleedings when they were young. Trends in reduction of joint impairment and increase of physical mobility are expected to continue in the coming decades, with a positive effect on social functioning.
Background There is clear epidemiological evidence for a relationship between social support and ... more Background There is clear epidemiological evidence for a relationship between social support and health. Though, the mechanism remains unclear whether a poor social support precedes or follows a poor health status. Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting particularly quality of life. Objectives First, to investigate cross-sectional relationships between quality of life and social support (SS) and support network (SN) in patients with early RA. Then to look at how baseline SS or SN influence quality of life over time; and last, to explore how variations over time in SS or SN affect quality of life over time. Methods Subjects were members of the EURIDISS population-based cohort from France, the Netherlands and Norway, and had suffered from RA for less than 5 years. Yearly assessments were made of SS, SN, psychological well-being (GHQ), and functional disability (HAQ). Variance and covariance analyses with repeated measures were calculated and adjusted for...
Patient compliance is considered necessary for the success of drug treatment in chronic diseases.... more Patient compliance is considered necessary for the success of drug treatment in chronic diseases. We document compliance with drug treatment and the factors affecting it in a cohort of patients with rheumatoid arthritis (RA). A prospective cohort study of 556 patients with RA followed for 3 years in 4 counties: Oslo, Norway; Groningen, The Netherlands; and Nancy and Reims, France. Compliance to treatment was assessed annually by interview in terms of adherence to the dose and timing of the prescribed drug regimen. Of the 556 subjects, 429 (77.2%) were taking medication for RA throughout the observation period. Consistent behavior was recorded in 59.5% of cases: 35.7% were consistently compliant, and 23.8% consistently noncompliant. Factors significantly associated with good compliance were older age (p = 0.00), female sex (p = 0.03), decreased disability (p = 0.04), very satisfactory contacts with health care professionals (p = 0.03), and more personal knowledge about the disease an...
To provide a description and identify risk factors for functional disability in early rheumatoid ... more To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. Consequences for the early management of RA ar...
OBJECTIVE To compare a disease specific measure of functional status, the Health Assessment Quest... more OBJECTIVE To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied. METHODS In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between T1 and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences. RESULTS The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are > 0.91 for ...
OBJECTIVE To delineate compliance with drug therapy in rheumatoid arthritis patients, determine s... more OBJECTIVE To delineate compliance with drug therapy in rheumatoid arthritis patients, determine specific characteristics of compliant and noncompliant patients, and look for changes in compliance over time. PATIENTS AND METHODS A prospective European cohort study (EURIDISS) recruited 556 patients in four countries over three years. Compliance with drug dosages and dosing times was evaluated yearly using a questionnaire. RESULTS Of the 556 patients, 429 (77.2%) were on drug therapy at all three evaluation time points. Use of steroids, nonsteroidal anti-inflammatory drugs, and second-line drugs varied significantly across countries. The compliance behavior was stable over time in 59.5% of them (35.7% of patients were consistently compliant and 23.8% consistently noncompliant); it was independent of disease duration and from the clinical features of the disease. Older patients and women were more likely to be compliant (odds ratios, 2.5 and 2, respectively). CONCLUSION Compliance with ...
XIth International Congress on Thrombosis and Haemostasis
Coagulation factor preparations became available in the treatment of hemophilia about twenty year... more Coagulation factor preparations became available in the treatment of hemophilia about twenty years ago, followed by the introduction of prophylactic therapy and home-treatment. The purpose of our longitudinal study was to quantify the impact of these treatment modalities on the medical and social situation of hemophiliacs.We carried out three mail surveys (1972, 1978 and 1985) among Dutch hemophiliacs. In 1985 we sent questionnaires to 1162 of the estimated total of 1300 patients with a response of 81%. Eighty-six percent of the respondents had hemophilia A, 14% hemophilia B; 41% had severe hemophilia (<1%) 19% moderately-severe (1-5%) and 40% mild hemophilia (>5%). Growth of prophylactic therapy and home-treatment for severe hemophilia was The mean age increased from 21 yrs in 1972 (n=435) to 29 yrs in 1985 (n=935)(general male population: 34 yrs). The number of manifest bleedings decreased from 25 in 1972 to 15 in 1985, with a corresponding decrease in the number of transfus...
Objective-To analyze how the patient himself perceives his physical and social situation 1 year a... more Objective-To analyze how the patient himself perceives his physical and social situation 1 year after Guillain-Barre´syndrome (GBS). Material and method-The Dutch patients who participated in an international multicenter trial were asked to complete a selfadministered questionnaire containing questions on their physical status at homecoming and at 12 months, as well as questions dealing with various aspects of their social condition. Results-Ninety patients participated. Up to 72% had sensory disturbances and loss of power in part of the arms and up to 89% in part of the legs at homecoming. At 12 months, a significant improvement had occurred, but residua were perceived in 36 and 67%, respectively. The residua ranged from irritating to seriously disturbing in up to 49%, and only 33% felt completely cured. Furthermore, 32% had changed their work due to GBS, 30% did not function at home as well as before and 52% had altered their leisure activities. Conclusion-One year after the onset of GBS, a considerable number of patients still perceived a decrease of power and sensation with an often disturbing effect. GBS had an evident impact on daily life and social well-being.
Arthritis care and research : the official journal of the Arthritis Health Professions Association, 1994
Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the ... more Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well-being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well-being. The focus of the present study is on the main effect versus the buffering effect of social support. Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home. Receiving more daily emotional support positively related to greater psychological well-being; whereas problem-oriented emotional support negatively related to some aspects of psychological well-being. People receiving more social companionship turned out to be less depressed. The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.
To provide a description and identify risk factors for functional disability in early rheumatoid ... more To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. Consequences for the early management of RA are underlined.
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