류마티스관절염 대상자의 피로 영향요인
Factors Affecting Fatigue in Patients with Rheumatoid Arthritis
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연구배경: 최근 류마티스관절염 치료제 개선으로 혈액염증수치를 포함한 질병활성도가 호전됨에도 불구하고 피로등 증상을 호소하는 대상자는 일정 수준으로 유지되고 있다. 피로는 류마티스관절염 대상자의 가장 흔한 주관적 증상이며, 건강행위 및 삶의 질에 영향을 미치는 주요 요인이다. 이에 본 연구에서는 류마티스관절염 대상자의 삶의 질향상을 위한 중재 개발의 기초자료 마련을 위하여, 피로 영향요인을 파악하고자 하였다. 방법: 경기도 소재 일개 대학병원 류마티스내과 외래를통원 중인 류마티스관절염 환자를 대상(n=246)으로 구조화된 설문지와 의무기록 리뷰를 통해 수집된 자료를 분석하였다. SPSS/WIN ver. 25.0 (IBM Corp, Armonk, NY, USA)를이용하여 기술통계, t-test, analysis of variance, pearson 상관분석 및 회귀분석을 이용하여 결과를 제시하였다. 결과: 연구 대상자의 피로는 10점 만점에 평균 4.4점이었으며, 56.5%는 DAS28을 기준으로 관해 수준으로 평가되었다. 피로에 유의한 영향을 미치는 요인은 통증과 학습된 무력감으로, 통증이 높을수록, 학습된 무력감이 높을수록 연구 대상자의 피로 수준이 높았다. 반면, 객관적 질병활성도지표인 DAS28에 따라 대상자의 피로 수준은 통계적으로유의한 차이가 없었다. 결론: 류마티스관절염 대상자 피로 수준을 낮추기 위해서는 통증 조절과 함께 학습된 무력감을 낮추는 것이 요구된다. 임상에서 대상자들을 마주할 때마다 대상자의 질병에대한 태도를 평가하고 관해에 대한 희망을 가질 수 있도록대상자를 적극 지지할 필요가 있다.
Abstract
Background: Despite the fact that disease activity, including blood inflammation level, has been lowered with the recent improvement in rheumatoid arthritis treatment, the number of patients appealing of symptoms, such as fatigue, is maintained at a certain level. Fatigue is the most common subjective symptom of patients with rheumatoid arthritis and a major factor influencing health behavior and quality of life. Therefore, this study aimed to identify the factors affecting fatigue to prepare basic data for the development of interventions to improve the quality of life of participants with rheumatoid arthritis. Methods: Cross-sectional data collected using structured questionnaires and medical record reviews were analyzed for 246 rheumatoid arthritis outpatients from a university-affiliated hospital. Results: Level of fatigue was an average of 4.4 out of 10, and 56.5% was evaluated as a remission level based on the disease activity score 28 (DAS28). Factors significantly affecting fatigue were pain and learned helplessness. Higher levels of pain and learned helplessness were associated with higher levels of fatigue. Conversely, there was no statistically significant difference in the fatigue levels of the participants according to the DAS28, objective disease activity index. Conclusions: To reduce the fatigue levels of the participants with rheumatoid arthritis, learned helplessness, including pain control, should be lowered. The participant’s attitude towards the disease should be evaluated and the participants should be actively supported to obtain hope for remission, if clinically encountered with participants.
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