Observational studyBMJ open2026
Relative strength of major determinants of quality of life in rheumatoid arthritis: an observational, cross-sectional study in tertiary rheumatology centres.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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16 authors.
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Abstract
objectivesTo evaluate the relative strength of clinical and sociodemographic predictors of health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) under real-life conditions.
methodsThis cross-sectional, observational study included adult patients fulfilling the 2010 American College of Rheumatology-European Alliance of Associations for Rheumatology classification criteria for RA, recruited from 11 public tertiary rheumatology centres in Brazil. To reflect real-life clinical practice, no restrictions were applied regarding disease stage or treatment status. HRQoL was assessed using the 12-item Short Form Health Survey (SF-12). Physical disability was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). Clinical and epidemiological variables were evaluated as candidate predictors. Associations were explored using bivariate analyses and multiple linear regression models. Standardised beta coefficients (zβ) were used to estimate the relative strength of independent predictors.
results1079 patients were included; 89.4% were women and 56.0% were white, with a mean (SD) age of 57.0 (11.4) years and a median (IQR) disease duration of 152 (84.0-242.0) months.In multivariate analysis, the following remained independently associated with physical score: HAQ-DI score (β=-3.92, 95% CI (-4.56 to -3.28), zβ=-0.44, p<0.001), non-white race (β=-0.97, 95% CI (-1.80 to -0.14), zβ=-0.71, p=0.022) and absence of regular physical activities (β=0.56, 95% CI (0.04 to 1.09), zβ=-0.07, p=0.036).For mental score, remaining independent predictors were HAQ-DI (β=-5.00, 95% CI (-6.17 to -3.83), zβ=-0.31, p<0.001), fibromyalgia (β=-5.52, 95% CI (-7.76 to -3.26), zβ=-0.15, p<0.001), white race (β=3.32, 95% CI (1.79 to 4.84), zβ=0.13, p<0.001), current smoking (β=-4.95, 95% CI (7.42 to -2.48), zβ=-0.12, p<0.001), female biological sex (β=3.91, 95% CI (-6.36 to -1.46), zβ=-0.10, p=0.002) and Simplified Disease Activity Index (β=-0.91, 95% CI (-0.17 to -0.02), zβ=-0.09, p=0.018).
conclusionPhysical disability was the strongest determinant of impaired HRQoL in both physical and mental domains among participants with RA. Other relevant determinants of poorer physical HRQoL in descending order of relative strength were non-White race and absence of regular physical activity, while for poorer mental HRQoL, fibromyalgia, race, smoking status, female sex and disease activity. These findings reinforce functional preservation as a key therapeutic target in routine RA care.
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