Comparative Effectiveness of Analgesic Regimens on Health-Related Quality of Life in Rheumatoid Arthritis: A Prospective Cross-Sectional Study from a Pakistani Tertiary Care Center

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that profoundly impacts health-related quality of life (HRQoL). While disease-modifying antirheumatic drugs (DMARDs) target underlying pathophysiology, the optimal integration of analgesic medications for symptom control remains inadequately characterized, particularly in resource-limited settings. Objective: This prospective cross-sectional study aimed to (1) assess HRQoL across five domains in RA patients, (2) evaluate associations between analgesic treatment patterns and HRQoL outcomes, and (3) identify predictors of poor HRQoL. Methods: A total of 120 adult RA patients were recruited from the Rheumatology Outpatient Department of Fauji Foundation Hospital, Rawalpindi, Pakistan, using consecutive sampling over six months (January–June 2024). HRQoL was measured using the validated EuroQoL-5D-5L (EQ-5D-5L) instrument. Pain severity was assessed using the Numeric Rating Scale (NRS). Medication data were extracted from medical records. Multivariable linear regression was performed to identify independent predictors of HRQoL, adjusting for age, gender, disease duration, comorbidity burden, and socioeconomic status. Results: The cohort was predominantly female (82.5%) with a mean age of 52.3 ± 11.7 years and mean disease duration of 7.8 ± 5.2 years. Severe problems were most prevalent in pain/discomfort (48.3%) and mobility (42.5%). Analgesic monotherapy was the most common regimen (45.8%), followed by combination therapy with DMARDs (32.5%). After adjustment for confounders, combination therapy (analgesics + DMARDs) was independently associated with superior EQ-5D-5L index scores (β = 0.142, 95% CI: 0.067–0.217, p < 0.001) compared to analgesic monotherapy. Depression (β = -0.189, p < 0.001) and high comorbidity burden (β = -0.156, p = 0.002) were significant predictors of poor HRQoL. Conclusion: RA exerts a multidimensional impact on HRQoL, with pain and mobility limitations being most pronounced. Combination therapy with analgesics and DMARDs was independently associated with superior HRQoL outcomes. These findings support integrated treatment approaches addressing both physical and psychological burden of RA. Prospective longitudinal studies are warranted to confirm causality.