Novel Tool Identifies Disease-Specific Distress in Patients With Rheumatoid Arthritis

Rheumatoid arthritis
Rheumatoid arthritis
Researchers determined the effect of disease-specific distress (DSD) among patients with rheumatoid arthritis (RA) and developed a patient-reported outcome measure to assess DSD in RA.

The Rheumatoid Arthritis Distress Scale (RADS) can help identify disease-specific distress (DSD) in patients with rheumatoid arthritis (RA), according to study findings published in BMC Rheumatology.

The study included a secondary analysis of 61 interviews conducted with patients with RA. These findings were validated using a Patient and Public Involvement (PPI) group with 4 patients. Following this phase, items were generated for a Patient Reported Outcome Measure (PROM), and face and content validity of the PROM were established via the PPI group. Finally, individual cognitive interviews with 9 patients were conducted, and the final PROM was presented at a Patient Education Evening for patients with long-term rheumatologic conditions and their caregivers.

Results from the secondary analysis revealed 5 themes of rheumatologic disease distress that were validated in the PPI. Initially, 94 items were generated for the RADS, which was trimmed down to 39 items and 3 supplementary questions. The items were grouped in the themes of distress, with items related to emotional distress placed before physical distress to better reflect patients’ journeys.

Participants reported that the RADS content was clear and relevant. Researchers concluded that DSD is experienced by patients with RA and that it is distinct from other conditions such as clinical depression and anxiety.

Study limitations included a small sample size that lacked patients of the male sex and patients from diverse socioeconomic and ethnic backgrounds; data from caregivers of patients with RA and idiopathic inflammatory myositis and antiphospholipid syndrome were included, which could have indicated that distress was not solely related to RA; and participants from the original interviews were not specifically asked about RA distress.

According to the researchers, “It appears RA distress shares some domains with other long-term condition specific anguish.” They added, “Following detailed psychometric evaluation, the RADS has the potential to be employed in larger longitudinal studies to identify the prevalence of RA distress.”


Silke L, Kirresh O, Sturt J, Lempp H. Development of the Rheumatoid Arthritis Distress Scale (RADS): a new tool to identify disease-specific distress in patients with rheumatoid arthritis. BMC Rheumatol. 2021;5(1):51. doi:10.1186/s41927-021-00220-4