Predictors of disease outcome in rheumatoid arthritis - UMC Utrecht

Coping and Social Support in Disease Activity - 39
for short-term disease fluctuations (Affleck et al., 1997; Zautra et al., 1997) may be
irrelevant to long-term outcomes (McFarlane & Brooks, 1990; Affleck et al.,
1997). In contrast to short-term changes from incidental stress encounters and
responses, long-term effects may be primarily influenced by chronic stressors and
relatively stable personality, coping and social support characteristics. Also the
strength and direction of relationships between stress and vulnerability factors and
disease activity may vary over time and be different for short and long-term
outcomes. Some effects may become evident only in the long term and factors may
even work in opposite directions in different time periods, e.g. due to a biphasic
pattern of immunological or behavioral responses that is differently related to
disease activity during and after the occurrence of major stress (Mullen & Suls,
1982; Koehler, 1985; Suls & Fletcher, 1985; McFarlane & Brooks, 1990; Huyser
& Parker, 1998). Finally, effects may also depend on the stages of disease assessed
(McFarlane & Brooks, 1990; Huyser & Parker, 1998). Preliminary evidence
suggests that stressors and vulnerability factors are differently related to physical
and psychological symptoms in early and long-standing RA (Smith et al., 1997),
possibly due to changes brought about by the disease itself. Stressors and
vulnerability factors in established RA have been shown to be affected by the
inflammatory processes of the disease, its biopsychosocial consequences and the
pharmacological treatment with prolonged medication (Evers et al., 1997; Fex et
al., 1998; van Jaarsveld et al., 1998, 2000; Penninx et al., 1999), and they may be
consequently more validly assessed in recently diagnosed patients (Zautra et al.,
1989; Smith et al., 1997; Huyser & Parker, 1998).
The purpose of the present study was to examine the role of stress-vulnerability
factors for their ability to predict long-term changes in disease activity in recently
diagnosed RA patients. Specifically, we studied the relative contribution of
personality characteristics (neuroticism and extraversion), physical and
psychological stressors (chronic disease-related stressors of functional disability,
pain, and disease impact on daily life, as well as major life events), coping and
social support at the time of diagnosis to changes in disease activity 1, 3 and 5
years later. In line with preliminary evidence suggested by current theories and
research, it was hypothesized that a more unfavorable course in disease activity
after 1, 3 and 5 years could be directly predicted by personality characteristics of
more neuroticism and less extraversion, higher levels of physical and
psychological stressors, more passive avoidant coping, less active problem-focused
coping and less social support at the time of diagnosis. In addition to these direct
effects, several mediator and moderator effects were exploratively investigated.
First, the mediating function of coping and social support for the relationship
between personality characteristics and change in disease activity and for the
relationship between stressors and change in disease activity was examined. In
addition, the mediation function of stressors for the relationship between
personality characteristics and change in disease activity, and of coping for the