Patients' Perspectives on the Psychological Impact of Inflammatory Arthritis and Meeting the Associated Support Needs: Open-Ended Responses in a Multi-Centre Survey.
Psychological support for inflammatory arthritis is recommended in rheumatology treatment guidelines. Previous research found that high numbers of patients would access such support but that provision is often inconsistent and inadequate. The present study explored patients' perspectives on the nature of the psychological impact of inflammatory arthritis and how to meet the associated support needs.



A cross-sectional survey was conducted, using questionnaires which included three open-ended questions about helpful and unhelpful psychological support. The questionnaires were administered to 1,080 patients at six regional rheumatology units across England, and 1,200 members of a national patient charity.



A total of 1,210 (53%) patients completed the questionnaire, with 779 (64%) responding to the open-ended questions: 80% female; mean age 59 years (12.6); disease duration <5 years (40%), 5-10 years (20%), >10 years (40%). Data were analysed using a hybrid content analysis. Four categories emerged: challenges of an altered life course (negative emotions, isolation and loneliness, a dysfunctional body, loss, strained relationships, and fears for the future); poor communication (feeling unheard, clinicians' reluctance to address psychological issues, a lack of help to manage pain and fatigue, and struggling to ask for help); understood by others (sharing with people who have arthritis, supportive family and friends, whole team support, and understanding from clinicians); and acquiring strategies (ways of coping).



Psychological distress was commonplace, and often attributed to fatigue and pain. In addition to peers and family, patients looked to the rheumatology team for validation and support. Further research will address the skills training needs of rheumatology teams to meet patients' psychological support requirements.
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Emma
E
Dures
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Isobel
I
Fraser
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Celia
C
Almeida
Academic Rheumatology, University Hospitals Bristol NHS Trust, Bristol, UK.
Alice
A
Peterson
Academic Rheumatology, University Hospitals Bristol NHS Trust, Bristol, UK.
Judy
J
Caesley
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Jon
J
Pollock
Pain Management Unit, North Bristol NHS Trust, Bristol, UK.
Nicholas
N
Ambler
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Marianne
M
Morris
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Sarah
S
Hewlett
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072858:Psychosocial Support Systems; D011795:Surveys and Questionnaires
Inflammatory arthritis; fatigue; pain; patient perspective; psychological support