Learned helplessness role in inflammatory polyarthritis revealed

Feb 26 2013

By Lynda Williams, Senior medwireNews Reporter

Learned helplessness (LH) is a modifiable risk factor that can significantly influence disease outcome in patients with inflammatory polyarthritis (IP), UK clinicians believe.

Deborah Symmons (University of Manchester) and co-workers found that that the level of patient LH at diagnosis - defined as feelings of little control over life and a passive response to problems - significantly influences IP-related pain, disability and fatigue at 2 years.

However, the degree of LH significantly varied in the patients over time, with around half showing an improvement at follow-up.

"Patients' feelings of LH should be addressed by clinicians, who may also consider providing patients with the information and support needed to overcome these feelings," the researchers recommend.

The study followed up 443 patients presenting to a primary care physician or rheumatologist with recent-onset IP, defined as two or more swollen joints for at least 4 weeks). The patients were assessed for LH using the Rheumatology Attitudes Index (RAI) at baseline and again 2 years later, as well as the British version of the Stanford Health Assessment Questionnaire (HAQ) for disability, and visual analog scales for pain and fatigue.

As reported in Rheumatology, baseline feelings of LH significantly and positively correlated with HAQ scores, with a 1-point increase in RAI per HAQ score increase. Baseline LH also positively correlated with greater pain and fatigue during follow-up.

But RAI scores were static in just 13% of patients, the researchers report. There was a median decrease of 1 point in scores between baseline and 2 years, with 50% of patients having a reduction in LH at 2 years and 37% an increase. One in five patients had a 5-point decrease, corresponding to an average 1-point decrease in score for each of the five questions.

"It may be the case that patients with high LH at baseline had a poor underlying prognosis; however, the analyses presented here were statistically significant despite adjustment for baseline disease severity, therefore this is unlikely to completely explain the relationship observed," Symmons et al comment.

They conclude that further research is warranted to determine the impact of LH over a longer follow-up period of follow-up.

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