Some Patients Classify RA Without DMARDs As “Worse than Death”

Gaujoux-Viala C, Fautrel B, Guillemin F, et al. Who are the patients with early arthritis with worse than death scores on the EQ-5D? Results from the ESPOIR cohort.Rheumatology (2013) 52:832-838.

Pope, J. Is having rheumatoid arthritis a fate worse than death? Rheumatology (2013) 52:767-768
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Pain, function and quality of life scores from 11% of patients with early arthritis rate the condition as “worse than death,” according to French researchers, with extreme pain and discomfort being a key determinant.

A cohort of 813 patients with suspected or diagnosed rheumatoid arthritis who were not taking DMARDs filled out the EuroQol (EQ)-5D questionnaire. The majority were women; the mean age was 48. The questionnaire asks patients to assess whether or not they have problems with function (mobility, self-care, performance of daily activities), pain/discomfort, and anxiety or depression.
The answers are rated on a scale of 0 to 100, with 0 (death) being the worst imaginable health state and 100 being the best possible health state.

At baseline, severe pain/discomfort prompted 90 patients to score their answers below zero, a “health status” worse than death.

Almost all patients with (EQ)-5D scores below zero had extreme pain/discomfort and at least moderate problems in usual activity, 59% had moderate anxiety/depression (40% had extreme anxiety/depression), and more than 90% reported moderate problems in mobility and self-care. The same distribution of profiles was found at 6, 12, and 24 months.

At two years, 24 patients (3.3%) still rated their health state as being worse than death.

A related editorial suggests that patients are likely adapt to their health state, especially after receiving treatment, with those who had higher pain at the outset needing greater levels of pain relief to consider their health state improved.