Measuring the Effects of Medication Use on Health-Related Quality of Life in Patients with Rheumatoid Arthritis: A Review

As the treatment of rheumatoid arthritis (RA) moves towards earlier and more consistently maintained therapy, often with highly toxic medications, the importance of assessing patients' health-related quality of life (HR-QOL) is of increasing concern to healthcare providers, insurers and policy-makers. As the course of RA can extend 20 years or more, and as patient involvement in their care and evaluation increases, the goal of therapy should be to work towards the HR-QOL desired by the patient. The challenge in HR-QOL measurement is its multidimensional nature, which takes into account not only how a person functions physically, mentally and socially, but also incorporates the individual's perceived well-being in their physical, mental and social aspects of daily life. This review focuses on measuring the HR-QOL outcomes of drug therapy in RA in clinical settings as well as in clinical drug trials. The most commonly used instruments in RA HR-QOL measurement are presented, with particular attention to those that have been used to assess the impacts of drug therapy. Traditionally, RA treatment outcomes assessment has focused on physical functioning and activities of daily living. As a result, there is an abundance of instruments that have been used in RA that measure physical functioning. Social and mental functioning are being assessed more frequently as clinicians and researchers recognise the added value of assessing these dimensions in addition to physical functioning. Patient perceived well-being (especially as it relates to physical, mental and social aspects of their lives), however, is still rarely measured. We conclude that there are few validated instruments which truly assess the impact of drug therapy on HR-QOL in RA; most are intended as measures of functional or health status. In addition, few studies have been conducted in natural clinical practice settings (as opposed to controlled clinical trial settings). Further, our review reveals that the psychological and social dimensions of HR-QOL are often lacking from some of the most popular RA instruments currently in use.