# Health-related quality of life among patients with rheumatoid arthritis in Zanzibar: a prospective cohort study

## TL;DR

This study found that patients with rheumatoid arthritis in Zanzibar had lower quality of life than healthy people, but it improved with treatment over one year.

## Contribution

The study provides new insights into HRQoL trends and factors in RA patients in a resource-limited setting.

## Key findings

- Patients with RA had significantly lower HRQoL than healthy controls at one year.
- HRQoL improved over one year with treatment, but remained lower than controls.
- Delayed diagnosis and higher disease activity were linked to poorer HRQoL.

## Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory illness that mainly affects the joints. Untreated, it causes deformity, poor health-related quality of life (HRQoL) and increased morbidity and mortality. There have been tremendous strides in RA therapies globally but with sparse availability in resource-limited settings. We aimed to evaluate HRQoL among patients with RA and its related factors.

132 patients with RA were enrolled and followed up for one year. The same number of healthy controls were recruited. HRQoL was assessed using the EuroQoL five-dimension five-level tool (EQ-5D). From the responses, utility and visual analog scale (VAS) scores were obtained. Analysis of variance and independent t tests were used to compare the utility and VAS scores for patient subgroups. Factors influencing HRQoL were investigated through multiple linear regression analysis. A p value of < 0.05 was considered significant.

At baseline, mean patient utility score was 0.50 ± 0.06 and increased to 0.66 ± 0.10 at one year (p < 0.05). Compared to controls, whose mean utility score was 0.93 ± 0.02, patients with RA at one year had lower HRQoL (p < 0.001). Time to diagnosis of ≥ 1 year and higher disease activity were associated with poorer HRQoL. Patient VAS scores also improved from baseline to one year but were significantly lower than controls.

HRQoL of patients with RA was lower than in controls but improved at one year indicating the impact of treatment. Reducing delays in diagnosis and initiating early and aggressive treatment may help to improve the HRQoL.

The online version contains supplementary material available at 10.1007/s11136-025-03974-3.