Factors Associated with Perceived Stress Among Patients with Rheumatoid Arthritis Receiving Disease-Modifying Antirheumatic Drug Therapy: A Cross-Sectional Study

Abstract

Background & Objective: Rheumatoid arthritis (RA) is a chronic autoimmune disease that has a significant psychological burden as well as physical manifestations. Although Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are the backbone of RA management, the association between treatment-related factors and perceived stress in patients treated with DMARDs is not well understood, especially in low- and middle-income countries. To assess the prevalence of perceived stress and to determine the demographic, clinical, and treatment-related factors associated with stress in RA patients on DMARD therapy at a tertiary care hospital in Pakistan. Methodology: A descriptive cross-sectional study was conducted in the Rheumatology Department of Saidu Group of Teaching Hospitals, MTI, Swat. A total of 199 RA patients (67.8% female, mean age 45.53±13.38 years) on DMARD therapy for at least 3-6 months were recruited by non-probability purposive sampling. Perceived stress was measured using the Perceived Stress Scale (PSS). Data were analyzed using SPSS version 27. Results: The mean perceived stress score was 22.52±6.53. Moderate stress was reported by 59.3% and high stress by 36.7% of the patients. The strongest correlation was between severity of pain and stress (r = 0.825, p < 0.001). Perceived stress and changes in pain with DMARDs (p<0.001), perceived participation (p<0.001), control over daily activities (p<0.001) and emotional exhaustion (p=0.002) were significantly associated. Married patients had significantly more stress than single patients (p=0.02). Patients with a family history of autoimmune diseases reported higher stress levels (p<0.01). Conclusion: Perceived stress is frequent among RA patients on DMARD therapy and pain severity is the strongest predictor. These findings highlight the need for integrated psychological assessment and management in routine rheumatology care. Key Words: Rheumatoid Arthritis, Perceived Stress, DMARDs.