This thesis of Alexandra Husivargová addresses the challenges encountered by established biologic-treated rheumatoid arthritis (RA) patients. Pharmacological treatment aims to achieve clinical remission; however, only 3% of patients did not report any RA-related problems during interviews. Physical problems, such as pain, fatigue, functional disability, and morning stiffness were mentioned by 97.2% of our patients, of which one-third also reported psychosocial distress, such as sadness, depression, or loneliness. Most of the RA patients were interested in additional non-pharmacological interventions.
Therefore, we aimed to apply a biopsychosocial approach to assess pain, fatigue, and reduced social participation, which were identified as the most common concerns patients encounter. Fatigue was studied as a multidimensional construct using cross-sectional data that revealed different factors associated with its psychological and physical dimensions. Pain and functional disability were associated with higher reported physical dimensions, and anxiety with mental dimensions of fatigue. We found that functional disability and illness perception were significantly associated with reduced social participation. Additionally, we investigated how the COVID-19 pandemic affected patients' lives. Longitudinal data collected before and after the pandemic showed increased pain and anxiety levels, however, clinical status remained unchanged. The thesis also studied factors that may mitigate persistent pain experienced by many RA patients. We found that illness perception was associated with pain in both data collections, functional disability played a role before, and fatigue after the pandemic. Our findings encourage the implementation of a biopsychosocial approach in clinical practice, which may lead to more efficient RA management.
