Understanding Health-related quality of life in rheumatologic diseases: insights from PROMIS® health domains.

BACKGROUND

Rheumatologic diseases significantly impact health-related quality of life (HRQoL), affecting physical, mental, and social well-being and pose unique challenges due to their wide range of symptoms. Patient-reported outcomes (PROs) provide valuable insights into how these diseases influence different dimensions of HRQoL, supporting personalized healthcare approaches.

METHODOLOGY: In this cross-sectional study, we examined HRQoL in 213 patients with rheumatologic diseases, including, among others, rheumatoid arthritis, localized pain disorders, connective tissue diseases, and rarer conditions such as vasculitis, using the EQ5D-5L and the Patient-Reported Outcomes Measurement Information System (PROMIS®) as well as Pain and HRQoL specific PROs. We provided PROMIS health domain scores of key health aspects such as physical function, fatigue, pain interference, and social participation. Additionally, we compared HRQoL and PROMIS domain scores with a German general population reference sample and conducted exploratory comparisons across the three most frequent principal diagnosis groups: systemic sclerosis, rheumatoid arthritis, and vasculitis. Moreover, we investigated which patient-reported health domains were most strongly associated with HRQoL in these diseases. Penalized regression models with elastic net regularization were used to identify stable predictors of HRQoL, followed by a pooled linear regression model for interpretation.

RESULTS

Individuals with rheumatic diseases had significantly lower HRQoL than the general population (EQ-5D-5L VAS mean: 55.4 versus 73.2). PROMIS T-scores indicated markedly reduced Physical Function (M = 36.5, SD = 9.6) and elevated pain interference (M = 61.7, SD = 9.2). Penalized regression analyses identified Physical Function, Fatigue, Ability to Participate in Social Roles and Activities as stable predictors of EQ-5D-5L VAS. Higher Physical Function and Social Participation were associated with higher HRQoL, whereas higher Fatigue was associated with lower HRQoL.

CONCLUSIONS

These results highlight the importance of PROs in understanding the patient experience in rheumatologic disease and identifying individual needs. Routine assessment of HRQoL domains may help recognize unmet needs and support individualized care in rheumatology.