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The impact of Rheumatoid Arthritis on quality-of-life assessed using the SF-36: A
systematic review and meta-analysis
Matcham
1
F,
Scott
2
IC ,
Rayner
1
L,
Hotopf
1
M,
Kingsley
3
G,
Scott
4
DL
& Steer
4.
S
1Department
of Psychological Medicine, Institute of Psychiatry, King's College London
2Academic Department of Rheumatology, King’s College London
3Department of Rheumatology, King’s College London School of Medicine
4Department of Rheumatology, King’s College Hospital, London
Background
We have demonstrated in a previous systematic
review that Rheumatoid Arthritis (RA) impacts on all
aspects of Quality of Life (QoL), with detrimental
effects observed in all 8 health domains of the
Medical Outcomes Study 36-item Short-Form Health
Survey (SF-36). The recent shift in the paradigm of
RA management towards early combination therapies
may have altered the impact of RA on QoL. We
therefore performed an updated systematic review
examining the impact of RA on QoL measured using
the SF-36, and are the first to present meta-analysed
data showing QoL in RA.
Methods
Medline and Embase were searched using the terms
Rheumatoid Arthritis or RA and Quality of Life or SF-36.
Observational studies were included that reported mean
and standard deviation scores for all SF-36 domains in
RA patients. Domain scores across studies were
combined within a meta-analysis to provide summary
scores for each domain. The clinical and psychosocial
Pooled mean SF-36 PCS scores in RA patients by random effects metaanalysis.
Pooled mean SF-36 scores
SF-36 domain
Pooled
Mean
95% Confidence
Interval
Physical Function
48.5
46.4-50.7
Role Physical
36.5
33.3-39.8
Bodily Pain
45.2
42.2-48.3
Global Health
46.8
44.4-49.1
Physical Component Summary
44.7
44.3-45.1
Vitality
47.5
42.1-46.3
Social Function
63.3
59.6-66.9
Role Emotional
53.9
50.3-57.6
Mental Health
63.1
59.7-66.4
Mental Component Summary
59.4
59.0-59.7
Reduced physical QoL was associated with increased
disease activity, physical disability, pain and fatigue;
reduced mental QoL was generally associated with
increased disease activity, pain, fatigue, and
increasing age.
Conclusions
RA impairs QoL, particularly the physical components
of the SF-36. QoL is associated with several
variables associated with QoL in RA were discussed
disease characteristics, including pain and
qualitatively.
fatigue. RA patients score markedly lower in both
Results
A total of 33 studies were eligible for inclusion in the
review, including 22,473 patients.
physical and mental domains than healthy
populations, and score similarly to or lower than
patients with other chronic conditions. Optimal care of
RA patients requires a broader clinical perspective,
taking into account patients’ physical and mental
health needs.
Pooled mean SF-36 MCS scores in RA patients by random effects meta-analysis.