The role of perceived and actual disease status in adjustment to rheumatoid arthritis

Objectives. To examine the role and relative impact of illness perceptions, coping strategies and clinical disease indicators on adjustment in patients with rheumatoid arthritis. Method. Participants were 75 women with rheumatoid arthritis. The Illness Perception Questionnaire (IPQ), the COPE questionnaire and the Arthritis Impact Measurement Scale (AIMS) were administered during a semistructured interview. Disease status was indicated by physician ratings of joint involvement and by the laboratory indices of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results. Statistically significant correlations (P<0.01) were in the expected direction. Various aspects of adjustment (good physical function, low pain and depression) were associated with perceptions of low illness identity, high control/cure, more serious illness consequences and long illness timeline. Low disease activity was related to good physical function. Depression was associated with high use of coping by denial and with less frequent use of five COPE strategies: active coping, planning, seeking instrumental social support, positive reinterpretation and growth, and acceptance. In hierarchical regression analysis, disease status explained variance in physical function (15%). Illness perceptions accounted for variance in all three adjustment outcomes, ranging from 22 to 27%. Coping variables did not add to the explanation of variance on adjustment. Conclusions. Illness perceptions have significant implications for adaptation to illness and they outweigh the impact of medical disease status on depression, physical function and pain. Health interventions based on understanding and modifying perceptions of illness may prove useful in facilitating patient well-being.