OBJECTIVE:To investigate whether greater social support and support network are cross-sectionally associated with less functional limitations and psychological distress in patients with early rheumatoid arthritis (RA); whether this association is constant over time; and whether increases in social support or support network are associated with less functional limitations and psychological distress.METHODS:Subjects were from the European Research on Incapacitating Diseases and Social Support cohort and had early RA. Social support, support network, functional limitations (Health Assessment Questionnaire), and psychological distress (General Health Questionnaire) were assessed annually. Variance and covariance analyses with repeated measures were performed.RESULTS:A total of 542 subjects were assessed for 3 years. On average, patients with a greater amount of specific social support or a stronger specific support network experienced less functional limitation and less psychological distress. Changes in a given subject's functional limitations and psychological distress did not depend on his or her baseline social support or support network. Neither social support nor support network change over time.CONCLUSION:There may be a cross-sectional link between specific social support or support network and functional limitations and psychological distress, but no longitudinal association could be evidenced.

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 potential confounding variables. Results A total of 542 subjects had yearly assessment for three years. On average, those receiving a greater amount of specific SS (daily emotional support or social companionship) (p = 0.05 to p = 0.0001) or surrounded by a stronger specific SN (those aspects providing emotional support) (p < 0.001) experienced a better quality of life. No statistically significant relationship was observed between baseline level of SS or SN and changes in quality of life over time. Similarly, changes in SS or SN did not appear to be associated with improvements in quality of life over time. Conclusion Better specific SS and specific SN are cross-sectionally associated with better quality of life in early RA patients. Baseline or changes in SS or SN do not seem to predict changes in quality of life over time for these patients. It may be useful to measure SS in early RA patients in order to identify individuals who receive little specific SS. Further work is needed to devise simple ways to measure SS, to develop interventions that provide additional support, and to investigate whether provision of structured SS by relevant professionals would be more useful than increasing non-specific intervention.

This article presents results from a follow-up study in the Netherlands among 292 patients with early rheumatoid arthritis (RA). The main focus of this paper is on (changes in) personality characteristics, coping strategies and psychological status between the first and second wave (T1 and T2). On personality characteristics and psychological status RA patients are compared with a reference group (N=173) from the general community.The levels of self-esteem, neuroticism and social desirability of RA patients were significantly different when compared to those of control subjects. As far as the coping strategies 'emotional expression' and 'confrontation' were concerned, RA patients presented less favourable scores than subjects from the reference group. Along the same line, psychological status was also found to be significantly different in the groups. The results on personality characteristics and psychological status remained stable after 12 months (T2). The patients' functional status appeared to be rather strongly associated only with level of self-esteem. In addition, depression on TI could be explained mainly by personality-related aspects rather than functional status and tenderness. This pattern was also present in explaining the variance of T2 depression. However, in this latter regression analysis functional status did not contribute to depression. From the results it can be concluded that factors related to the disease process such as activity restrictions and tenderness, are not or only slightly related to the psychological status of RA patients. In addition, personality characteristics, especially the level of self-esteem, appeared to be an important determinant of depressive mood in patients with RA. These findings may contribute to the treatment of RA patients by explicitly paying attention to the relevance of personality-related aspects in (self-) management programmes.

Recently, a new instrument was developed to measure social support. It consists of two parts; the Social Support Questionnaire for Transactions (SSQT) and the Social Support Questionnaire for Satisfaction with the supportive transactions (SSQS). The SSQT measures the number of supportive interactions and has proved to have good psychometric properties. From the taxonomy that was used for the present study, it results that social support in general consists of two aspects. These are, on the one hand, actual supportive transactions and, on the other hand, the perception of being supported or the satisfaction with the social support provided. In the present study, two research questions were addressed. The first concerned the psychometric properties of the SSQS, measuring the individual's satisfaction with the supportive interactions provided. Secondly, the relative contribution of both supportive interactions (the SSQT) and the satisfaction with the support provided (the SSQS) were assessed, in explaining the level of health related quality of life outcome. The data of 744 rheumatoid arthritis (RA) patients from four different countries (116 French, 238 Norwegian, 98 Swedish and 292 Dutch patients) were used in the present study. At the entry of the study, all patients fulfilled four out of seven American Rheumatism Association (ARA) criteria and had a disease duration of 4 years or less. The results of the study indicate that the SSQS has good psychometric properties across countries. Cronbach's α for the emotional support scales was 0.80 or more, and for the instrumental support subscales around 0.60. The standardized regression coefficients demonstrated that, compared to supportive interactions, support satisfaction was more relevant in explaining health related quality of life measures, although it is recommended that the SSQT and SSQS be used to complement each other.

As part of an international European research project, a longitudinal study was started by the end of 1990 in the northern part of The Netherlands. The study concentrated on recently diagnosed RA patients (N=292), i.e., incident cases up to four years. According to the duration of the disease, five groups of patients had been formed. The early influence of rheumatoid arthritis on medical parameters, on functional status, on physical condition and on psychological well-being was evaluated. From the results, an overall statistically significant pattern related to the duration of the disease could not be distingiushed. However, patients recently diagnosed did face activity restrictions, a decline in physical condition and social functioning. On medical parameters this deterioration is less profound. Furthermore, across and within the five patient groups, it seems that males and females respond differently to the influence of early RA. Based on cross-sectional data from the five onset cohorts, the present findings do not significantly suggest a steady worsening in medical, physical and psychological condition.

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 TI 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 both instruments. For patients who improved between T1 and T2, measured by the Ritchie Articular Index, the standardized response mean of the HAQ and the GARS were moderate, whereas for patients who worsened, the standardized response means were small. The results based on the relative efficiency were ambiguous. Furthermore, the mean score for women on the HAQ was 0.25 higher in contrast to scores for men. The GARS did not yield different scores for women and men.Conclusion. The internal consistency of the GARS and the HAQ are comparable. The HAQ has yielded different results for women and men. Therefore, when the HAQ is used, sex differences should be taken into account. With respect to sensitivity to change, the GARS and the HAQ obtained much better results for patients who improved in contrast to patients who worsened. The GARS was found to be more sensitive to change for patients who improved.

PURPOSE: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.METHODS:Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home.RESULTS: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.CONCLUSION:The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.

The present study addresses the relationship between early rheumatoid arthritis and an element of personality i.e. the self-esteem, as an intervening variable on psychological well-being. From a sample of 292, more or less recently diagnosed RA-patients, the relationships between disease parameters, self-esteem and psychological well-being were studied. Five subgroups of patients have been formed according to the duration of the disease: from four years disease duration up to incident cases. Disease parameters such as the duration of RA or the sedimentation rate is not associated with patients' self-esteem. The self-esteem of RA-patients is negatively related to the level of joint tenderness. Also, the lower the self-esteem of patients, the lower the level of psychological well-being. Joint tenderness with the patients' level of self-esteem explain 34% of the scoring on psychological well-being.

OBJECTIVE:To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA).METHODS: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.RESULTS: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.CONCLUSION:Consequences for the early management of RA are underlined.