Psychological Distress in Rheumatoid Arthritis: Efficacy of Fear Assessment Questionnaire

The FAIR questionnaire may be useful to identify psychological stress in rheumatoid arthritis patients.

The Fear Assessment in Inflammatory Rheumatic (FAIR) diseases questionnaire may be useful to evaluate the levels of fear and psychological distress in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA), according to the results of a recent prospective cross-sectional validation study published in the Annals of the Rheumatic Diseases.

Participants were recruited by hospital and community rheumatologists between July 2014 and October 2015. All patients completed a preliminary questionnaire, along with the patient global assessment of overall disease activity (scored from 0 to 10), the Hospital Anxiety and Depression Scale (HADS), the Arthritis Helplessness Index (AHI), and the Bath Ankylosing Spondylitis Disease Activity Index (for patients with axSpA). Patients also provided information on socioeconomic indicators, health insurance, disease duration, and family history of rheumatic disease. Rheumatologists provided information on the patient’s disease activity, assessed using the 28-item Disease Activity Score calculated with erythrocyte sedimentation rate for RA and an overall assessment of disease activity scored from 0 to 10.

A total of 672 patients were included in the study — 432 with RA and 240 with axSpA. Most of the participants had moderate disease activity and were receiving biologic therapy. The final questionnaire included 10 questions with high internal consistency and a single dimension. Mean scores were 51.2±25.4 in patients with RA and 60.5±22.9 in patients with axSpA. Groups of patients who had high (17.2%), moderate (41.1%), and low (41.7%) fear scores were identified. High fear scores were associated with high AHI scores (odds ratio [OR], 6.85; 95% CI, 3.95-11.87), high levels of anxiety (OR, 5.80; 95% CI, 1.19-4.22) and depression (OR, 2.37; 95% CI, 1.29-4.37), low levels of education (OR, 3.48; 95% CI, 1.37-8.83), and high perceived disease activity (OR, 2.36; 95% CI, 1.10-5.04).

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”The FAIR is short (10 items), simple to score and may be a useful tool both in routine practice and clinical trials,” noted the investigators, adding, “It may be helpful for physicians taking care of patients with RA and axSpA to evaluate the levels of fear and psychological distress in their patients, to provide an appropriate level of psychological support and to initiate a physician-patient dialogue to dispel unwarranted fears and facilitate adaptive coping.”


Gossec L, Chauvin P, Saraux A, et al. Development and psychometric validation of a patient-reported outcome measure to assess fears in rheumatoid arthritis and axial spondyloarthritis: the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire [published online November 4, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212000.

This article originally appeared on Rheumatology Advisor