Abstract
Objective To evaluate the relationship between major life stressors in the year prior to diagnosis and RA symptoms and function at diagnosis and 1 year.
Methods Data were from adults with RA in the Canadian Early Arthritis Cohort, a multi-center inception cohort from 01-2007 to 03-2017 with ≥12 months of follow-up. Patients completed questionnaires about stressful life events in the prior year, HAQ, SF-12, and 11-point rating scales of sleep, fatigue, pain, and patient global. Group characteristics were compared with ANOVA or chi-square and adjusted multivariable regression models examined the impact of stressors on symptoms and function at 1-year.
Results The 1933 participants were mostly White (87%) women (72%) with a mean age of 55 years; 52% reported 1+ stressors in the year prior to diagnosis. Around diagnosis, patients reporting major stressors had significantly worse mean HAQ, depression, sleep, fatigue, pain, and patient global which generally worsened with the type and number of stressors. At 1 year, the odds of depression and disability and ratings of pain, fatigue, poor sleep, and patient global generally increased with an increasing number of stressors though SDAI improved similarly among groups.
Conclusion 52% of new RA patients reported stressful life events in the year prior to diagnosis which were associated with worse disability, depression, pain, fatigue, sleep and wellbeing but not SDAI at diagnosis. Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI. Results highlight the potential independent contributions of environmental and psychological factors in RA onset and course.
