HEALTH-RELATED QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS USING SF-36, IN A TERTIARY HOSPITAL IN KPK, PAKISTAN

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder associated with significant physical disability, pain, fatigue, and psychosocial impairment, all of which adversely affect health-related quality of life (HRQoL). Local data regarding HRQoL among patients with RA in Khyber Pakhtunkhwa remain limited.

Objective: To assess health-related quality of life in patients with rheumatoid arthritis using the SF-36 questionnaire and to determine the association of demographic and clinical variables with HRQoL.

Methods: This cross-sectional study was conducted at the Medical B Unit of Ayub Teaching Hospital over a period of six months. A total of 60 adult patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria were included through consecutive non-probability sampling. HRQoL was assessed using the Short Form-36 (SF-36) questionnaire. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Associations between HRQoL categories and demographic or clinical variables were analyzed using the Chi-square test. A p-value of ≤0.05 was considered statistically significant.

Results: The mean age of participants was 46.8 ± 11.2 years, and 76.7% were females. The majority of patients belonged to rural areas (61.7%), were married (81.7%), and had disease duration greater than 5 years (50.0%). The overall mean SF-36 score was 43.5 ± 12.9. The lowest mean domain scores were observed in bodily pain (34.7 ± 17.3), vitality (36.8 ± 15.9), and role limitation due to physical health (38.9 ± 21.7), while comparatively higher scores were observed in social functioning (52.4 ± 18.6) and mental health (50.8 ± 16.7). Poor HRQoL was identified in 60.0% of patients, moderate HRQoL in 28.3%, and good HRQoL in 11.7%, while none demonstrated excellent HRQoL. Female gender (p=0.012), rural residence (p=0.031), and lower educational status (p=0.008) were significantly associated with poorer HRQoL. Among clinical variables, disease duration >5 years (p=0.003), morning stiffness ≥1 hour (p=0.019), recent disease flare-ups (p=0.001), and treatment with conventional DMARDs alone (p=0.041) showed significant association with poor HRQoL. Physical health component scores (40.1 ± 14.8) were lower than mental health component scores (46.9 ± 15.2).

Conclusion: Patients with rheumatoid arthritis demonstrated substantial impairment in health-related quality of life, particularly in physical health domains. Poorer HRQoL was significantly associated with female gender, rural residence, lower educational status, prolonged disease duration, morning stiffness, and recent disease flare-ups. Routine assessment of HRQoL using SF-36 may help identify vulnerable patients and support more comprehensive patient-centered management strategies in resource-limited tertiary care settings.