title: An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA).
  
  
  METHODS
  A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI.
  
  
  RESULTS
  Lower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes.
  
  
  CONCLUSIONS
  The findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.
authors.affiliation: University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA. pnicassio@mednet.ucla.edu
authors.forename: Perry M
authors.initials: PM
authors.lastname: Nicassio
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Kay
authors.forename: Mara K
authors.initials: MK
authors.lastname: Custodio
authors.forename: Michael R
authors.initials: MR
authors.lastname: Irwin
authors.forename: Richard
authors.initials: R
authors.lastname: Olmstead
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weisman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011788:Quality of Life; D012720:Severity of Illness Index