Abstract
ObjectiveTo evaluate the impact of spinsterhood on disease characteristics and quality of life (QoL) in Moroccan women with rheumatoid arthritis (RA).Methods185 women with RA were recruited in this study. Marital status was specified as follow: 1. Spinsterhood (never-married woman aged 38 or over), 2. Distressed marriage; 3. Nondistressed marriage and 4. Divorced or widowed. Marital distress was assessed by a self-report concerning coping efficacy and burden caring of husbands. Assessment criteria included the evaluation of: age at onset (years), diagnosis delay (months), disease duration (years), disease activity (evaluated by physical examination, biological inflammatory tests; and disease activity score (DAS 28)), pain intensity (measured with a visual analogue scale (VAS)); and radiographic damage (evaluated by the Sharp's method as modified by van der Heijde). Treatments (doses and duration) were specified. The Health Assessment Questionnaire (HAQ) was used to evaluate functional disability. QoL was measured using the Arabic version of the generic instrument SF-36.ResultsIn our data, spinsterhood was detected in 42 (22.7%) patients vs. 88 (47.5%) with distressed marriage, 28 (15.1%) with nondistressed marriage and 27 (14.6%) divorced or widowed. Comparing the 4 groups, we found that QoL in never-married women was damaged in a significant way comparing to the other groups. Mental as well as physical aspects were affected. Also, we found that spinsterhood was associated to an early age at onset (p = 0.009), pain intensity (p < 0.001); clinical (p < 0.001) and biological disease activity (C-reactive protein; p = 0.02) and functional disability (p < 0.001). Logistic regression analysis revealed a significant relationship between spinsterhood and early age at onset and severe functional disability (for all p ≤ 0.01).ConclusionThis study suggests that spinsterhood in our RA patients was associated with an altered QoL even compared with distressed married women. Also, we state that spinsterhood was associated with an early age at onset, severe joint pain; higher disease activity and with altered functional ability. It seems important to consider not only disease-related parameters but also social status as a determinant factor of poor course in RA.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disease which has great impact on general well-being, functions of daily life and the fulfillment of social roles [1]
It has been suggested that marital status could be associated with worse outcome in women with RA and that marriage may be associated with a lower rate of
In ANOVAs Analysis of variance performed with Bonferroni correction, we found that spinsterhood was associated to an early age at onset (p = 0.009), pain intensity (VAS pain) (p < 0.001); clinical and biological disease activity (DAS28 (p < 0.001) and CRP (p = 0.02)) and functional disability (HAQ) (p < 0.001)
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disease which has great impact on general well-being, functions of daily life and the fulfillment of social roles [1]. It has been suggested that marital status could be associated with worse outcome in women with RA and that marriage may be associated with a lower rate of. In the Arab region, demographic patterns of marriage status have changed significantly in recent decades [5]. Marriage has declined sharply in parts of the Arab world and the rate of celibacy or spinsterhood has increased significantly [5]. No Maghrebean or Arabic data have focused on the impact of spinsterhood on disease characteristics among women with RA. The aim of the present study was to evaluate spinsterhood and its relationships with disease variables and quality of life (QoL) in Moroccan women with RA
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