title: Physical and Mental Functioning in Patients with Established Rheumatoid Arthritis over an 11-year Followup Period: The Role of Specific Comorbidities.
abstract: OBJECTIVE
  To investigate the longterm association of a wide range of comorbidities with physical and mental functioning in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Longitudinal data over a period of 11 years were collected from 882 patients with RA. Somatic comorbidity and comorbid depression were measured at baseline, with a questionnaire including 20 chronic diseases and with the Center for Epidemiologic Depression Scale, respectively. Physical functioning was measured at 5 timepoints with a disease-specific measure [Health Assessment Questionnaire (HAQ)] and a generic measure [physical scales of the Medical Outcomes Study Short Form-36 (SF-36)]. Mental functioning was measured with the mental scales of the SF-36. To determine the association of baseline-specific comorbidities with functioning over time, we performed longitudinal analyses.
  
  
  RESULTS
  At baseline, 72% percent of the patients were women, mean age ± SD was 59.3 ± 14.8 years, median RA disease duration was 5.0 years, and 68% had ≥ 1 comorbid condition. The effect of comorbid conditions was more apparent when physical functioning was measured with SF-36, a disease-generic measure, compared with the HAQ, a disease-specific measure. Circulatory conditions and depression were associated (p < 0.05) with worse physical functioning according to the HAQ. Respiratory conditions, musculoskeletal conditions, cancer, and depression were associated (p < 0.05) with worse physical functioning according to the SF-36. Respiratory conditions and depression were associated with worse mental functioning.
  
  
  CONCLUSIONS
  Patients with specific comorbid conditions have an increased risk of low functioning in the long term. Targeted attention for these specific comorbid conditions by clinicians is recommended.
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam. j.vd.hoek@reade.nl.
authors.forename: Joëlle
authors.initials: J
authors.lastname: van den Hoek
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam.
authors.forename: Leo D
authors.initials: LD
authors.lastname: Roorda
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam.
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Tijhuis
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam.
authors.forename: Geertrudis A
authors.initials: GA
authors.lastname: van den Bos
authors.affiliation: From the Amsterdam Rehabilitation Research Center | Reade; Department of Social Medicine, Academic Medical Center, University of Amsterdam; Departments of Rehabilitation and Psychiatry, EMGO Institute, Vrije Universiteit (VU) University Medical Center Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Biometrics, Wageningen University and Research Centre, Wageningen, the Netherlands.J. van den Hoek, MSc, Amsterdam Rehabilitation Research Center | Reade, and Department of Social Medicine, Academic Medical Center, University of Amsterdam; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center | Reade; H.C. Boshuizen, PhD, National Institute of Public Health and the Environment, and Biometrics, Wageningen University and Research Centre; G.J. Tijhuis, MD, PhD, Amsterdam Rehabilitation Research Center | Reade; G.A. van den Bos, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam; J. Dekker, PhD, Amsterdam Rehabilitation Research Center | Reade, and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center Amsterdam.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000150:complications*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications*; D011788:Quality of Life; D012120:Respiration Disorders / Q000150:complications*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: COMORBIDITY; DEPRESSION; LONGITUDINAL; MENTAL FUNCTIONING; PHYSICAL FUNCTIONING; RHEUMATOID ARTHRITIS