IM7.21 | Rheumatologic Disease Quality of Life — Summary & Reflection

KEY TAKEAWAYS

Rheumatologic disease impact on quality of life (IM7.21) is assessed and managed through a biopsychosocial framework covering three ICF levels: impairment, activity limitation, and participation restriction.

Key QoL domains and their PROMs:
- Functional disability: HAQ-DI (0–3; ≥1.0 = significant disability; MCID 0.22)
- Fatigue: FACIT-Fatigue (0–52; ≤30 = clinically significant fatigue)
- Depression/anxiety: PHQ-9 (≥10 = moderate depression, needs management) and GAD-7 (≥10 = moderate anxiety)
- Work productivity: WPAI-RA/AS (presenteeism ≥40% = significant work impairment)
- Generic HRQoL: SF-36 (PCS and MCS subscales compared to population norms)

Key clinical principles:
- Biological remission (DAS28 remission) ≠ patient remission (HAQ may still be elevated due to central sensitisation, depression, deconditioning)
- Fatigue in RA and SLE is multifactorial — treat inflammation, anaemia, sleep, depression, deconditioning; prescribe graded aerobic exercise
- Work disability in 30–50% of RA patients within 10 years — prevent with early DMARD + occupational therapy + ergonomic adjustment
- Depression prevalence 15–47% in rheumatologic disease — screen with PHQ-9 at every encounter in high-risk patients
- Sexual health affected in 50–70% of RA/SLE patients — ask directly; use normalising language

Referral thresholds: Physiotherapy (HAQ ≥1.0), occupational therapy (work/self-care impact), psychology (PHQ-9 ≥10), social work (financial burden, work disability), rheumatology nurse educator (newly diagnosed).

REFLECT

Return to Priya from the opening hook — the 29-year-old graphic designer whose RA is 'controlled' but whose life is being destroyed. She cannot work, she is concealing her diagnosis from her fiancé, she is waking at 3 am catastrophising about her future. Her DAS28 would look reassuring in a clinical chart. How many clinic encounters would go by without anyone asking her these questions, if QoL assessment was not part of the protocol? Think about how you would open that conversation — not with 'your blood tests are fine' but with 'before we look at the results, tell me how your arthritis has been affecting your daily life.' Now consider the three self-assessment cases and what each one would look like in an unstructured clinic encounter versus one where a structured QoL tool was administered. The habit of assessing quality of life as systematically as you assess disease activity is not an additional burden on the clinical encounter — it is what converts the encounter from a test-review to a consultation.