Causes and Impacts of Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is a chronic, systemic and generally progressive disorder of unknown origin which affects connective tissues. RA is commonly manifested by inflammation of the synovial membrane of joints, immobility and general fatigue (1). Concurrent and symmetric polyarticular inflammation, which is its first clinical symptom, initially involves the small joints in the hands and feet (2).

RA knows no geographical or racial boundaries and may occur at any stage of life. Its prevalence and incidence increases with age (3). According to other studies, its global prevalence rate is reported as 1% and such rate is the same worldwide (2, 4). According to the World Health Organization’s 2002 annual report, RA accounts for 0.8% of total years lived with disability. Besides, the mortality rate of people affected is twice than that of general population at the same age. Also, the rate of its prevalence is significantly increasing in the recent years (2, 5).

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Furthermore, women are more likely to develop such disease than men as 70% of the patients suffering from RA are women. The disease, which mostly occurs in the fourth and fifth decades of life, can disrupt normal daily activities (2, 6). RA may cause numerous physical complications among which chronic pain, fatigue, impaired mobility and limb deformities are the major ones (7).

RA-induced complications are not limited to apparent limitations in mobility and activities of daily living; but obscure systemic effects of such disease can also lead to organ failure, death or serious health problems such as pain, fatigue, sleep disturbance and changes in self-image. Such complications can cause disabilities and permanent changes in the patients (8).

The chronic nature of rheumatic diseases necessitates obtaining the required knowledge about the disease to make sound decisions for managing the health condition and developing a treatment plan tailored to the patient’s lifestyle. Fundamental objectives and strategies to deal with such diseases includesuppressing inflammation and autoimmune response, controlling pain, maintaining or improving joint mobility and functional status as well as increasing the patients’ awareness of the disease process (8).

Encouraging patients to adopt correct and proper self-care behaviors is an important factor which contributes to successful management of the disease (9). Self-efficacy also seems extremely important in managing RA.Unpredictable courses of the disease and its varying activity can make the patients find their disease uncontrollable which, in its own turn, can decrease their self-efficacy in managing it (10).

Self-efficacy is a form of self-confidence defined as one’s belief in one’s own ability to successfully organize and accomplish a particular task, behavior or any changes in cognitive status regardless of the underlying terms and conditions (11, 12). It is also a prerequisite for behavior change which affects the amount of efforts and level of performance (13).

People with higher levels of self-efficacy hold a belief that they are able to control their life events effectively. Such perception and belief, which can affect their behaviors directly, create a standpoint for them different from that of people with poor self-efficacy (11). Hence, self-efficacy is a critical factorcontributing to the success and failure of people throughout their lives. Individuals’ perceptions of such sense, is the most powerful predictor of their ability to change risky behaviors. It also determines how they face obstacles and difficulties.

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The people with low self-efficacy are easily convinced that their attempts are useless so they quickly stop striving. However, those with high self-efficacy not only can remove the barriers by improving self-management skills and persistence, but they also can stand against problems and have more control over their affairs. Besides, reinforcing self-efficacy can result in maintaining and preserving health-promoting behaviors (14). Its significant role in the initiation and maintenance of healthy behaviors,in case of occurrence of any disease such as arthritis, asthma and diabetes mellitus occurs, has been frequently reported by researchers (15). Previous studies have shown that using structured education can improve it in patients suffering from chronic obstructive pulmonary disease as well (16). It is also reported that increased self-efficacy could improve self-care skills and behaviors in the patients with diabetes mellitus (17).

The evidence show that it is essential to enable the patients to take care of themselves using scheduled training programs, which are based on patient-centered approaches, including patients’ active participation in improving their quality of life.It is of extreme importance due to several reasons such as priority of prevention to treatment, the chronicity of the disease, shorter hospital stay and spending recovery period at home as well as the problems of access to health care (18-20).

Atak et al (2010) reported the significant effect of education and subgroups of regular exercise, choosing healthy diet and controlling complications of the disease on the mean of total self-efficacy scores in the patients with diabetes mellitus (21). Furthermore, the results of another study revealed that education could significantly affect perceived self-efficacy in the patients with arthritis with respect to their ability to exert control over pain; however, it was not significant in terms of shin-related exercises. The researchers justified the lack of educational effects on exercise-related self-efficacy by explaining that training in a limited period of time cannot enhance the patients’ confidence in taking such action due to severe complications such as joint stiffness, pain and inflammation they experienced (22).تکراری

Vikery et al conducted a similar study to examine the effect of self-care trainings on disease outcomes. The obtained results showed that self-care training could decrease morbidity, the number of medical visits required and consequently healthcare costs (23). Even a small percentage increase in the self-care of chronic conditions can have major effects on reducing the demand for specialized services in health care (24).

Patrich (2008) believe that without training the patients and their participation in their self-care process, health care will be more costly and quality of life will be more impaired (25).Patient training is a vital aspect of nursing care for those with arthritis to enable them to live as independently as possible, take their medications correctly and safely and use assistive devices properly. Such training is focused on the type of disorder, possible changes resulting from the disorder, prescribed treatment regimen, side effects of the medications and strategies to maintain individuals’ independence and performance as well as patient’s safety at home (8).

Several studies showed that training the patients can raise their knowledge and result in the improvement of self-management activities and health status so that they can prepare themselves for decision-making and compliance with the treatment regimen (26). It is worth mentioning that the aim of training the patients with chronic diseases is to sustain their behavior change for a longer period of time and even until the end of life.Due to the nature of the disease, immediate changesare not expected to be seen; for example prompt resolution of disabilities and difficulties is not expected to occur in case of chronic diseases such as arthritis. However, self-management training seems essential and profitable; so, the patients should obtain required knowledge and skills needed for decision-making and solving their own problems and those related to communicating with others (27).