title: Patient and spouse appraisals of health status in rheumatoid arthritis and fibromyalgia: discrepancies and associations with invalidation.
abstract: OBJECTIVE
  The health problems of patients with rheumatoid arthritis and fibromyalgia are mostly invisible to others, which can lead to a discrepancy between patients' and spouses' appraisals of the severity of the health problems. As a consequence, some patients may feel 'invalidation' from their spouse, such as not being understood and believed. Aim of this study was to compare patients' and spouses' appraisals of the health status of patients with rheumatoid arthritis and patients with fibromyalgia, and to examine whether discrepancies in these appraisals are associated with invalidation experiences of the patient.
  
  
  METHODS
  Eighty-four patients with rheumatoid arthritis and 95 patients with fibromyalgia filled out a health status questionnaire (MOS short-form general health survey, SF-20) and a questionnaire on invalidation by the spouse (Illness Invalidation Inventory, 3*I). The spouses appraised the patients' health status independently from the patients using a spouse version of the SF-20.
  
  
  RESULTS
  Patients with fibromyalgia and their spouses appraised the patients' health status significantly worse than patients with rheumatoid arthritis and their spouses. The agreement between patients and spouses was generally fair with somewhat more agreement in rheumatoid arthritis than in fibromyalgia. Patient-spouse discrepancies in health status appraisals were not associated with invalidation experiences.
  
  
  CONCLUSIONS
  The invisibility of health problems in fibromyalgia and rheumatoid arthritis is not accompanied by large patient-spouse discrepancies of health status appraisals, which suggests that invalidation by spouses is not dependent on observable evidence such as clinical signs of damage or pathology.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands. m.b.kool@uu.nl
authors.forename: M B
authors.initials: MB
authors.lastname: Kool
authors.forename: H
authors.initials: H
authors.lastname: van Middendorp
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: R
authors.initials: R
authors.lastname: Geenen
mesh_terms: D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires; D013577:Syndrome