Stressful Life Events in the Year Prior to Diagnosis and Associations With Rheumatoid Arthritis Characteristics at Presentation and 1 Year Later

OBJECTIVE: To evaluate the relationship between major life stressors in the year prior to diagnosis and rheumatoid arthritis (RA) symptoms and function at diagnosis and at 1 year. METHODS: Data were from adults with RA in the Canadian Early Arthritis Cohort, a multicenter inception cohort from January 2007 to March 2017 with ≥ 12 months of follow-up. Patients completed questionnaires about stressful life events in the prior year: Health Assessment Questionnaire-Disability Index (HAQ-DI); 12-item Short Form Health Survey; and 11-point rating scales of sleep, fatigue, pain, and patient global assessment (PtGA). Group characteristics were compared with ANOVA or chi-square test, and adjusted multivariable regression models examined the effect of stressors on symptoms and function at 1 year. RESULTS: The 1933 participants were mostly White (87%) women (72%) with a mean age of 55 years; 52% reported ≥ 1 stressors in the year prior to diagnosis. Around diagnosis, patients reporting major stressors had significantly worse mean HAQ-DI, depression, sleep, fatigue, pain, and PtGA, which generally worsened with the type and number of stressors. At 1 year, the odds of depression and disability, and ratings of pain, fatigue, poor sleep, and PtGA generally increased with an increasing number of stressors, though Simplified Disease Activity Index (SDAI) improved similarly among groups. CONCLUSION: Fifty-two percent of patients with newly diagnosed RA reported stressful life events in the year prior to diagnosis that were associated with worse disability, depression, pain, fatigue, sleep, and well-being, but not SDAI, at diagnosis. Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI. Results highlight the potential independent contributions of environmental and psychological factors in the onset and course of RA.