الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
R
heumatoid arthritis is an autoimmune, inflammatory disease that causes pain, swelling, stiffness, and loss of function in various joints (most commonly in the hands, wrists, and knees).The respective joint’s lining becomes inflamed, leading to tissue damage, as well as chronic pain, unsteadiness, and deformity. There is generally a bilateral/symmetrical pattern of disease progression (e.g., both hands or both knees are affected). RA can also affect extra-articular sites, including the eyes, mouth, lungs, and heart. Patients can experience an acute worsening of their symptom (disease flare) but with early intervention and appropriate treatment, symptoms can be ameliorated for a certain duration (disease remission) (Iqbal et al., 2019).
Aim of the study:
This study was aimed to assess factors affecting self management of patients with rheumatoid arthritis. It was achieved through the following:
• Assess patient’s knowledge about rheumatoid arthritis.
• Assess factors affecting self-management of patients with rheumatoid arthritis.
• Assess patient’s self-efficacy related to self- management of patients with rheumatoid arthritis.
Research question:
What are the factors affecting self- management of patients with rheumatoid arthritis?
Subjects and methods
Research design:
A descriptive exploratory research design was utilized to meet the aim of the study.
Setting:
This study was carried out at the National Medical Institute of Damanhur –affiliated to the General Organization for teaching hospitals and Institutes at the Medical clinics in the out- patient department.
Subjects:
A purposive sample of 100 adult patients with rheumatoid arthritis (75) females and (25) males in the previously mentioned setting was selected to conduct this study through the following inclusion criteria; patients who diagnosed for rheumatoid arthritis more than 3 months, both gender (males & females), free from other psychological and neurological illness and able to comprehend and communicate verbally.
Tools for data collection:
Four tools were used to collect data of the current study as following:
Tool (I): Rheumatoid Arthritis Patient’s Interviewing Questionnaire (AppendixI): It was written in simple Arabic language and divided into three parts:-
a. The first part: it was concerned with the socio-demographic characteristics of patient under study (age, gender, educational level, marital status, income, housing condition, and occupation.
b. The second part: it was used to assess the patients` clinical data (past and present history of the disease including; onset, duration and manifestations of the disease and length of receiving treatment.
c. The third part: it was used to assess the patients’ knowledge about rheumatoid arthritis and its associated self- management.
Tool (II): Rheumatoid Arthritis Disease Activity Scale (DAS-28): it was concerned with detection of disease activity and its effect as a factor which may affect on self-management of patients with rheumatoid arthritis and it was used to assess disease activity in 28 joints of the body and it was consisting of 4 parts; (the number of joints affected with joint tenderness, the number of swollen joints, erythrocyte sedimentation rate (ESR), and the visual analogue scale (VAS) of patient’s global health. The 28 tender or swollen joint scores target the same joints (shoulders, elbows, wrists, metacarpophalangeal joints, proximal interphalangeal joints and the knees).
Tool (III): Rheumatoid arthritis self-efficacy questionnaire: it was translated into Arabic language and back translation was done. It was used to measure tasks specific self-efficacy and its effect on of self-management.
Tool (IV): Rheumatoid Arthritis Self-Management self-reported checklist: it was written into Arabic language. It was used to assess self-management of patients with rheumatoid arthritis through 8 dimensions (exercise, rest & sleep, relaxation & stress management, pain management, joint protection & energy onservation, diet & food supplements, drug management and social support.
Result:
The results of this study revealed that:
- Regarding socio-demographic characteristics, 75% of the studied patients were females, 45% of them were aged from 50-60 years and 48% of them had secondary education.
- In relation to health history, 68% of the studied patients weren’t hospitalized for rheumatoid arthritis, 38% and 35% of them had history of hypertension and diabetes respectively, 60% of them suffered from rheumatoid arthritis more than 5 years and 75% of them adhere to their medical regimen.
- Related to patients’ total knowledge about rheumatoid arthritis and its associated self-management, 58% of the studied patients had unsatisfactory level of knowledge about the self-management of rheumatoid arthritis.
- Regarding to total disease activity, 18% of the studied patients were in remission state, and 32% had low level of disease activity while 50% of them had moderate and high level of disease activity.
- Regarding total self- efficacy, 52% of the studied patients had moderate level of self-efficacy and 28% of them had high level of self-efficacy.
- Regarding to total self- management, 50% of the studied patients had moderate level of total self-management and 32% of them had high level of total self-management.
- The present study revealed that, there were highly statistically significant relation between total knowledge about rheumatoid arthritis and its associated self- management of studied patients and both of their education level and job. While, there were statistically significant relation between total knowledge and both of their age and residence.
- The present study showed that, there were highly statistically significant relation between total disease activity of studied patients and both of gender and job. Moreover, there were statistically significant relation between total disease activity and both of their age and residence. Also low and remission level of disease activity were higher among age group between 40-<50.
- The studied patients and their total self-efficacy, the present study revealed that, there were highly statistically significant relation between total self-efficacy of studied patients and their education level. Also, there were statistically significant relation between total self-efficacy and both of their age, gender and job. Also high level of self-efficacy were higher among age group <30 years
- The present study showed that, there were highly statistically significant relation between total self- management of studied patients and their education level. Moreover, there were statistically significant relation between total self-management and both of their age, gender and job. Also high level of self-management were higher among age group <30 years.
- The present study revealed that, there was highly significant positive correlation between total knowledge of the studied patients and both of their self-efficacy and self- management.
- Also, there was highly significant positive correlation between total self-efficacy of the studied patients and total self- management. While, there was highly significant negative correlation between total disease activity of the studied patients and both of their self-efficacy and self- management.
- Finally, there were significantly higher frequencies between duration of illness and self-efficacy with self-management. Also, there were slight frequencies between anxiety & stress, financial burden, social support and total knowledge with self-management.while, he frequency of total self-management was not predicted by presence of other health problem.
Conclusion
Based on the results the present study concluded that:
More than half of the studied patients had unsatisfactory level of knowledge about rheumatoid arthritis and its associated self- management. Half of the studied patients were in remission state and had low level of disease activity. While, less than half of them had moderate and high level of disease activity. More than half of the studied patients had moderate level of self-efficacy. Half of the studied patients had moderate level of total self-management.
This study found that there was statistically significant relation of socio-demograhic characterestics (age, gender, educational level, and occupation) with self-management. Also, there was highly significant positive correlation between total knowledge of the studied patients and self-efficacy with self- management. While, there was highly significant negative correlation between total disease activity of the studied patients and self- management. Moreover, in the multiple regression model, anxiety and stress, financial status, patients’ knowledge, disease activity, duration of disease, self efficacy and social support remained significant predictors of self management of rheumatoid arthritis. Knowledge of these factors is particularly important, in order to optimize self-managementpractices which will subsequently lead to the refinement of patients’ health-related quality of life (QoL) and well-being.
Recommendations
Based on the results of the present study, the following recommendations are suggested:
In services:
• Self-care educational program should become an integrated part of the total management of RA patient.
• Educational media including: booklet, handouts, videos, posters, and CDs should be available for all patients at all times.
• The health education program should be available for every patient’s with rheumatoid arthritis based on the patient’s physical, psychological, social and spiritual needs.
• Establish a center for the patient education with RA provided with teaching aids and facilities to teach patients and their families’ways to live with RA
• A written policy on self-care instruction describing basic standards is recommended to be established
In research:
• Further research studies are needed to focous on studing psychological factors affecting selfmanagement of rheumatoid arthritis.
• Further research studies should be focus on self-management educational programs for patients with RA.
• Replication of the study on a larger probability sample selected from different geographical areas in Egypt is recommended to obtain more generalizable data.