Psychologie a její kontexty, Vol.5, No.2

Revmatoidní artritida jako psychický problém
Rheumatoid arthritis as psychic problem

Jiří Kaas, Valérie Tóthová, Lukáš Martinek

Článek se zabývá problematikou psychických potíží u pacientů s revmatoidní artritidou. Jsou v něm prezentovány dílčí výsledky výzkumného projektu Grantové agentury Jihočeské univerzity v Českých Budějovicích číslo 120/2012/S "Odraz kvality života v ošetřovatelství". Součástí výzkumu bylo též zmapovat subjektivně vnímanou kvalitu života nemocných s revmatoidní artritidou v oblasti prožívání a odhalit tak subjektivní psychické problémy, se kterými se nemocní potýkají. Výzkumný soubor tvořilo 200 pacientů trpících revmatoidní artritidou z celé České republiky, v poměru 150 žen a 50 mužů. Vlastní šetření probíhalo v období od ledna do května roku 2013. Výsledky přinesly informace o tom, že různě intenzivní subjektivní psychické problémy pociťuje až 90 % dotázaných. Dále byla prokázána statisticky významná souvislost mezi psychikou a fyzickými projevy, jako je únava a bolest. Lze tedy říci, že čím intenzivnější únavu a bolest nemocný pociťuje, tím větší jsou jeho psychické potíže a naopak. Toto zjištění je důkazem nezbytnosti komplexního přístupu k nemocnému s revmatoidní artritidou s větším uplatněním odborníků z oblasti psychologie.

Klíčová slova:
revmatoidní artritida, psychika, deprese, komplexní terapeutický přístup

The article deals with the issue of psychic problems of rheumatoid arthritis patients. Rheumatoid arthritis is a chronic, inflammatory motor system disease with comprehensive impact on the patient's life. The disease is often considered an exclusively physical disease. But such approach is insufficient because the disease is accompanied by motor limitations of different intensities, by pain and by fatigue that cause considerable exhaustion to the patient. The patients often must give up their hobbies and in some cases even their jobs. In most serious cases, even common daily activities including self-servicing actions become an obstacle to the patient. It is therefore logical that the psyche of a patient with such disease is considerably strained.
One of the partial goals of the study consisted in mapping the subjectively perceived quality of life of rheumatoid arthritis patients in facet 8, "negative feelings", and in ascertaining whether there is statistically significant relation to facets 1, "pain and discomfort", and 2, "energy and fatigue". Another goal consisted in comparing the subjectively perceived quality of life between men and women with rheumatoid arthritis, as well as between population of rheumatoid arthritis patients and control healthy population.
The study was implemented within the research project of the Grant Agency of the University of South Bohemia in České Budějovice number 120/2012/S, "Reflection of quality of life in nursing", under use of two standardized questionnaires, WHOQOL-100 and HAQ. This article presents exclusively the data acquired based on the WHOQOL-100 questionnaire. The research set consisted of patients suffering from rheumatoid arthritis from all over the Czech Republic. The size of the set was determined by a statistician at 200 individuals suffering from the disease, in a ratio of 150 women and 50 men. The selection set was derived from the basic set of rheumatoid arthritis patients and can therefore be considered representative with regard to the whole Czech population of rheumatoid arthritis patients. The actual selection of respondents was carried out based on quota selection, at specifying two quotas: presence of the diagnosis of rheumatoid arthritis" and "gender". The data collection took place from January to May 2013. 214 questionnaires were distributed in total, to achieve the required return amount of 200. The return rate was 93,5 %. The statistical data analysis was performed in two stages. The first degree of data sorting was implemented in the SASD program (Statistic Analysis of Social Data); the second degree was implemented in the SPSS program (Statistical Package for the Social Science), version 15.0.
It was ascertained based on the study that up to 90 % of respondents feel problems of different intensity in psychic area. 73,5 % of respondents perceive the problems as obstacle of different intensity to daily life. 66 % respondents reported actual feelings of depression. A very surprising finding consisted in the result of comparison of facet 8, "negative feelings", between the population suffering from rheumatoid arthritis and the control healthy population. Based on the comparison, it was found out that the control healthy respondents reported psychic problems in almost the same frequency and intensity as the rheumatoid arthritis patients. Such a high frequency and sameness to rheumatoid patients occurred probably due to wrong interpretation of the question from the respondents' perspective, particularly in healthy population that uses the term of "depression" relatively often for different common feelings of sadness and mood changes every person faces repeatedly in common life. It is not possible to admit that such a high percentage of healthy population suffers from actual depression. No statistically significant difference was found from the perspective of genders, based on comparison of results of facet 8, "negative feelings". Based on evaluation of relations between facet 8 (negative feelings) and facet 1 (pain and discomfort) and 2 (energy and fatigue), it was found out that there is statistically significant relation between the facets. It can be therefore accepted that patients feeling more intensive fatigue and pain experience more psychic problems and vice versa. The results evidence that therapy of rheumatoid arthritis as somatic disease is not sufficient and that comprehensive approach considering all patient's aspects should be applied in this area.

Keywords:
rheumatoid arthritis, psyche, depression, comprehensive therapeutic approach