title: Learned helplessness predicts functional disability, pain and fatigue in patients with recent-onset inflammatory polyarthritis.
abstract: OBJECTIVE
  Cross-sectional studies have found that learned helplessness (LH) is associated with disease outcome in patients with RA. However, little is known about the longitudinal impact of LH. The aim of this study was to investigate whether LH is associated with future disease outcome (disability, pain and fatigue) and to investigate whether LH changes over time in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent.
  
  
  METHODS
  Patients included in this investigation had been recruited to the Norfolk Arthritis Register, a primary-care-based inception cohort. LH was measured at baseline as patients' total score on the Rheumatology Attitudes Index (RAI). A total of 443 patients completed the HAQ and visual analogue scales of pain and fatigue at baseline and after 2 years of follow-up.
  
  
  RESULTS
  Greater feelings of LH at baseline were associated with higher HAQ scores at follow-up [difference in HAQ score per 1-point increase in RAI score (β-coefficient) 0.02; 95% CI 0.01, 0.04]. Greater baseline LH was also associated with more pain (β-coefficient 1.0; 95% CI 0.4, 1.5) and more fatigue (β-coefficient 1.0; 95% CI 0.2, 1.4) at follow-up. LH was highly changeable during follow-up, with 87% of patients showing any change and 50% improving.
  
  
  CONCLUSIONS
  Baseline LH independently predicted disability, pain and fatigue at follow-up. Half of patients reported fewer feelings of helplessness after 2 years of follow-up, suggesting that LH may potentially be a modifiable risk factor for disease outcome in IP and a target for intervention.
authors: Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
authors: Elizabeth M
authors: EM
authors: Camacho
authors: Suzanne M M
authors: SM
authors: Verstappen
authors: Jacqueline
authors: J
authors: Chipping
authors: Deborah P M
authors: DP
authors: Symmons
mesh_terms: D000368:Aged; D001168:Arthritis / Q000175:diagnosis* / Q000503:physiopathology; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005221:Fatigue / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006380:Helplessness, Learned; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: fatigue; functional disability; inflammatory polyarthritis; learned helplessness; pain; rheumatoid arthritis