IMPACT OF DISEASE-ACTIVITY ON THE QUALITY-OF-LIFE OF CROHNS-DISEASE PATIENTS

Crohn's disease (CD) patients often suffer severe symptoms that impair their quality of life. A sample of 39 CD patients who were assessed u sing well validated measures of disease activity and disease-specific quality of life is reported. Twenty-six of these patients were reasses sed an average of four months after the initial assessment to determin e the impact of changes in disease activity on quality of life. For th e total sample (n=39) disease activity did not predict quality of life for any of the scales of the Inflammatory Bower Disease Questionnaire (IBDQ) (r<0.13 for each), Thus, examining fluctuations in disease act ivity between patients did not demonstrate a disease activity quality of life relationship. In contrast, changes in disease activity within the same individuals over time (the repeat assessment sample, n=26) we re correlated with changes in quality of life; increases in disease ac tivity predicted decreases in quality of life on the IBDQ bowel sympto ms subscale (r=-0.463, P<0.01) and the IBDQ systemic symptoms subscale (r=0.44, P<0.05). The 10 patients with the largest decrease in diseas e activity over time (mean decrease of 43.54 points using the Dutch Ac tivity Index) had significant improvement in quality of life on the bo wel and systemic subscales. In contrast, the nine patients with the la rgest increase in disease activity over time (mean increase of 20.57 p oints using the Dutch Activity Index) had significant reduction in qua lity of life an the boa el and systemic symptoms subscales. These diff erences between extreme groups were significant for both the bowel sym ptoms (P<0.05) and systemic symptoms (P<0.05) subscales. The authors c onclude that changes in disease activity affect some important aspects of quality of life: aspects related to disease specific (bowel sympto ms) and nondisease-specific (systemic symptoms) physical symptoms. Imp ortantly, disease activity was not able to predict the emotional and s ocial aspects of IBD-related quality of life. This suggests that nondi sease factors need to be considered when working with CD patients. Fut ure research should evaluate the role of psychological intervention in improving quality of life for patients with reduced well-being, parti cularly in areas of emotional and social functioning.