Lifestyle habits and quality of life in established rheumatoid arthritis

Sammanfattning: Rheumatoid Arthritis (RA) is a chronic, inflammatory, and systemic disease of unknown aetiology that affects 0.5‒1.0% of the population in Europe, more women than men. Pain, physical disability, fatigue, and sleep disturbances are some of the most pronounced symptoms in patients with a more severe disease or with a longer disease duration, resulting in activity limitations that affect quality of life. RA is associated with an increased risk of developing comorbidities, some of which are known to be associated with a sedentary lifestyle. A healthy lifestyle can reduce the risk to develop diseases and help to improve quality of life in patients with RA. In guidelines and recommendations for management of patients with RA, health professionals are encouraged to prioritise discussions about lifestyle, especially physical activity, diet, smoking, and alcohol use. The overall aim of the present work was to explore factors that affect disability and quality of life in patients with established RA, especially on lifestyle habits (physical activity, diet, smoking, and alcohol use) and whether they are addressed in the clinic. The papers are based on a cohort of patients with established RA included in the Better Anti-Rheumatic Pharmacotherapy (BARFOT). Paper I is a longitudinal cohort study based on baseline and 5-18 years follow-up data from 1,387 patients who responded to a lifestyle questionnaire in 2010. Paper II is based on a qualitative content analysis, including interviews with 22 patients. Paper III is based a phenomenographic approach, including interviews with. 22 patients. Paper IV is a cross-sectional study including 1,061 patients who responded to a lifestyle questionnaire in 2017. Function and pain at onset of disease in patients with RA were found to be prognostic measures of a worse physical function several years later but none of the variables studied could predict who did or did not meet WHO recommendations for physical activity in 2010. Quality of life in patients with established RA was influenced by the balance between the ideal situation and the reality with regard to the lifestyle habits physical activity, diet, smoking, and alcohol use. These lifestyle habits influenced quality of life through limitation, selfregulation, and companionship. Quality of life was conceived as independence in terms of physical functioning and financial resources, as empowerment in how to manage life, and as participation in the experience of belonging in a social context. Although being regarded as important, lifestyle habits had not regularly been discussed at health care visits, and was not always requested by the patients. This implies the importance of that health care professionals actively discuss lifestyle habits from a biopsychosocial perspective as an integral part of RA management.