The top 5 themes identified surrounded fear as the dominant emotion, social connections and work, physical health, self-identity, and self-management as a way of coping.
Feelings of fear and vulnerability, which affected self-identity, were high throughout the COVID-19 pandemic and negative effects on social wellbeing increased overtime in patients with rheumatoid arthritis (RA). This prompted patients to utilize self-management skills to maintain wellbeing. However, physical health was generally unaffected, according to a study published in BMJ Open.1
“RA… requires specific drug treatment to suppress disease activity and prevent joint deformity,” investigators explained. “To manage the ongoing symptoms of joint pain and fatigue patients are encouraged to engage in self-management activities. People with RA have an increased incidence of serious illness and mortality, with the potential to impact on quality of life.”
In the qualitative, longitudinal study, investigators analyzed factors relating to physical, psychological, and social wellbeing in patients with RA during the COVID-19 pandemic at baseline (September to November 2020) and after 2 to 4 months (January 2021) via telephone interviews. Two patients with RA were chosen to participate in all stages of the research, including the study design, preparing public facing information, topic guides, and data analysis. Information was evaluated using interpretative phenomenological analysis.
In total, 15 adults with RA participated in the study. Average disease duration was 22±13 years, 9 participants were female, and ages ranged from 46 to 79 years. Most (n = 10) patients self-reported as retired.
The top 5 themes identified surrounded fear as the dominant emotion, social connections and work, physical health, self-identity, and self-management as a way of coping. Fear was the predominant emotion, which remained during both interviews, and social wellbeing increased between the baseline interview and the follow-up period. Patients reported feeling frightened, which was increased by factors regarding drug treatments for RA, as well as helpless and resentful at the start of the pandemic. Social interactions were mostly limited to phone calls and working remotely caused some participants to feel disconnected from their coworkers.
Although patients had difficulty in determining whether physical manifestations were attributed to RA or COVID-19, physical health was not affected during this time. Self-identity was affected by the recognition of increased risk and vulnerability; however, participants utilized self-management techniques to cope with these issues during the pandemic.
The 2 longitudinal interviews strengthened the study by allowing investigators to evaluate changes in this patient population. The research group’s involvement, including 2 patient partners, elevates the credibility of the results. There was also a diverse age representation, disease duration, and gender. However, generalizability was limited because participants were solely White and primarily older. Future studies with a more diverse sample of patients may be beneficial to understand the impact of COVID-19 in people with varied social differences, including those with more active disease, to understand the effect of self-management and symptom identification more fully. Lastly, socioeconomic information was not collected.
“Given the novelty of this longitudinal work and the exploration of biographical disruption, specifically on self-identity, we suggest that future research could expand on this in order to understand the impact of the pandemic on self-identity and social role (including work) in younger people with RA,” investigators concluded.
Ryan S, Campbell P, Paskins Z, et al. Exploring the physical, psychological and social well-being of people with rheumatoid arthritis during the coronavirus pandemic: a single-centre, longitudinal, qualitative interview study in the UK. BMJ Open. 2022;12(7):e056555. Published 2022 Jul 26. doi:10.1136/bmjopen-2021-056555
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