Research Article| Volume 44, P52-58, June 2023

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Eating attitude in patients with rheumatoid arthritis: The relationship between pain, body mass index, disease activity, functional status, depression, anxiety and quality of life

Published:April 17, 2023DOI:


      • RA is the most common musculoskeletal disease in the world.
      • Eating attitude is an important component of the quality of life with RA patients.
      • Possible causes of eating attitude in RA include pain, limitation of movement, and psychological disorders such as depression and anxiety.
      • When RA patients have negative eating attitudes, their anxiety and depression levels increase and their quality of life decreases.



      The aim of this study is to evaluate the relationship between eating attitude and pain, body mass index, disease activity, functional status, depression, anxiety and quality of life in patients with rheumatoid arthritis (RA).

      Design and methods

      This descriptive and cross-sectional study was conducted with 111 RA patients between January 2021 and May 2021.


      The Eating Attitudes Test scores of the participants had a positive significant relationship with their Visual Analog Scale scores (r = 0.257), Health Assessment Questionnaire scores (r = 0.221), Beck Anxiety Inventory scores (r = 0.287), Beck Depression Inventory scores (p = 0.224), and Rheumatoid Arthritis Quality of Life Scale scores (r = 0.298) (p < 0.05). This study showed that when the eating attitudes of the RA patients were negative, their anxiety and depression levels increased, and their quality of life was negatively affected.

      Practice implications

      In the positive management of depression and anxiety, by creating treatment guidelines, the moderation of the eating attitudes of patients and increasing their quality of life levels should be ensured.



      RA (Rheumatoid Arthritis), EAT (Eating Attitude Test), BDI (Beck Depression Inventory), BAI (Beck Anxiety Inventory), RAQoL (Rheumatoid Arthritis Quality of Life), VAS (Visual Analog Scale), HAQ (Health Assesment Questionnaire), BMI (Body Mass Index), DAS-28 (Disease Activity Score-28)
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        • Akça D.
        • Şentürk S.
        Effect of eating attitudes of individuals with type 2 diabetes upon quality of life.
        International Journal of Health Services Research and Policy. 2020; 5: 99-110
        • Baratzadeh A.
        • Kashaninia Z.
        • Mohaddess F.
        • Jokar M.H.
        • Haghani S.H.
        Effect of self-care education on the functional status of patients with rheumatoid arthritis.
        Iran Journal of Nursing. 2021; 34: 70-81
        • Beck A.T.
        • Ward C.
        • Mendelson M.
        Beck depression invontory (BDI).
        Archives of General Psychiatry. 1961; 4: 561-571
        • Berube L.T.
        • Kiely M.
        • Yazici Y.
        • Woolf K.
        Diet quality of individuals with rheumatoid arthritis using the healthy eating index (HEI)-2010.
        Nutrition and Health. 2017; 23: 17-24
        • Beşirli A.
        • Alptekin Ö.J.
        • Kaymak D.
        • Özer A.Ö.
        The relationship between anxiety, depression, suicidal ideation and quality of life in patients with rheumatoid arthritis.
        Psychiatric Quarterly. 2020; 91: 53-64
        • Bulut N.
        • Tezcan E.M.
        Emotional eating is more frequent in obese rheumatoid arthritis patients.
        Clinical Nutrition ESPEN. 2020; 35: 81-84
        • Cohen J.
        Statistical power analysis fort he behavioral sciences.
        Lawrence Erlbaum, Hillsdale, NJ1988
        • de Jong Z.
        • van der Heijde D.
        • McKenna S.
        • Whalley D.
        The reliability and construct validity of the RAQoL: A rheumatoid arthritis-specific quality of life instrument.
        British Journal of Rheumatology. 1997; 36: 878
        • de Resende Guimarães M.F.B.
        • Rodrigues C.E.M.
        • Gomes K.W.P.
        • Machado C.J.
        • Brenol V.
        • Krampe S.F.
        • Kakehasi A.M.
        High prevalence of obesity in rheumatoid arthritis patients: Association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study. Advances.
        Rheumatology. 2019; 16, 59: 44-49
        • Deb A.
        • Dwibedi N.
        • LeMasters T.
        • Hornsby A.J.
        • Wei W.
        • Sambamoorthi U.
        Burden of depression among working-age adults with rheumatoid arthritis.
        Hindawi Arthritis. 2018; 11
        • El-dadamony F.N.
        • Taha M.N.
        • Mahmoud F.S.
        Nutritional status and life style among rheumatoid arthritis clients at Zagazig University Hospitals.
        Zagazig Nursing Journal. 2018; 14: 80-96
        • Garner D.M.
        • Garfinkel P.E.
        The eating attitudes test: An index of the symptoms of anorexia nervosa.
        Psychological Medicine. 1979; 9: 273-279
        • Gezer I.A.
        • Balkarli A.
        • Can B.
        • Bagcaci S.
        • Küçükşen S.
        • Kucuk A.
        • Balkarlı A.
        Pain, depression levels, fatigue, sleep quality, and quality of life in elderly patients with rheumatoid arthritis.
        Turkish Journal of Medical Sciences. 2017; 47: 847-853
        • Gioia C.
        • Lucchino B.
        • Tarsitano M.G.
        • Iannuccelli C.
        • Di Franco M.
        Dietary habits and nutrition in rheumatoid arthritis: Can diet ınfluence disease development and clinical manifestations?.
        Nutrients. 2020; 12: 1456
        • Grygielska J.
        • Klak A.
        • Raciborski F.
        • Manczak M.
        Nutrition and quality of life referring to physical abilities - A comparative analysis of a questionnaire study of patients with rheumatoid arthritis and osteoarthritis.
        Reumatologia. 2017; 55: 222-229
        • Gülfe A.
        • Geborek P.
        • Saxne T.
        Response criteria for rheumatoid arthritis in clinical practice: How useful are they?.
        Annals of the Rheumatic Diseases. 2005; 64: 1186-1189
        • Hager J.
        • Bang H.
        • Hagen M.
        • Frech M.
        • Trager P.
        • Sokolova V.M.
        • Zaiss M.M.
        The role of dietary fiber in rheumatoid arthritis patients: a feasibility study.
        Nutrients. 2019; 11: 2392
        • Hisli N.
        Validity and reliability of the BECK depression ınventory for university students.
        Journal of Psychology. 1989; 7: 3-13
        • Itaya T.
        • Torii M.
        • Hashimoto M.
        • Tanigawa K.
        • Urai Y.
        • Kinoshita A.
        • Morinobu A.
        Prevalence of anxiety and depression in patients with rheumatoid arthritis before and during the COVID-19 pandemic.
        Rheumatology. 2021; 60: 2023-2024
        • Katchamart W.
        • Narongroeknawin P.
        • Chanapai W.
        • Thaweeratthakul P.
        • Srisomnuek A.
        Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: A multicenter prospective cross-sectional study.
        International Journal of Rheumatic Disease. 2020; 23: 302-308
        • Kirsten F.
        • Carol H.
        • Charles B.
        • Christine P.
        • John W.
        • Lesley G.
        • Ann R.
        Systematic review and meta-analysis of ınterventions for depression and anxiety in persons with rheumatoid arthritis.
        Journal of Clinical Rheumatology. 2017; 23: 425-434
        • Knippenberg A.
        • Robinson A.G.
        • Wincup C.
        • Jury C.E.
        • Kalea Z.A.
        Plant-based dietary changes may improve symptoms in patients with systemic lupus erythematosus.
        Lupus. 2022; 31: 65-76
        • Kücükdeveci A.A.
        • Şahin H.
        • Ataman S.
        • Griffi B.
        • Tennant A.
        Issues in crosscultural validity: Example from the adaptation, reliability and validity testing of a Turkish version of the Standford Health Assessment Questionnaire.
        Arthritis Care Research. 2004; 15, 51: 14-19
        • Kutlay S.
        • Küçükdeveci A.
        • Gönül D.
        • Tennant A.
        Adaptation and validation of the Turkish version of the rheumatoid arthritis quality of life scale.
        Rheumatology International. 2003; 23: 21
        • Macfarlane V.T.
        • Abood M.H.
        • Pathan E.
        • Gordon K.
        • Hinz J.
        • Macfarlane J.G.
        Relationship between diet and ankylosing spondylitis: A systematic review.
        European Journal of Rheumatology. 2017; : 1-24
        • Makri E.
        • Michopoulos I.
        • Gonidakis F.
        Investigation of loneliness and social support in patients with eating disorders: A case-control study.
        Psychiatry International. 2022; 3: 142-157
        • Markaki G.A.
        • Gkiouras K.
        • Papakitsos C.
        • Grammatikopoulou G.M.
        • Papatsaraki A.
        • Loannou R.
        • Bogdanos P.D.
        Disease activity, functional ability and nutritional status in patients with rheumatoid arthritis: An observational study in Greece.
        Mediterranean Journal of Rheumatology. 2020; 31: 406-411
        • Marrie R.A.
        • Hitchon C.A.
        • Walld R.
        • Patten S.B.
        • Bolton J.M.
        • Sareen J.
        • Bernstein N.C.
        Increasing burden of psychiatric disorders in rheumatoid arthritis.
        Arthritis Care Solution (Hoboken). 2018; 70: 970-978
        • Matcham F.
        • Norton S.
        • Scott L.D.
        • Steer S.
        • Hotopf M.
        Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: Secondary analysis of a randomized controlled trial.
        Rheumatology. 2016; 55: 268-278
        • McGarrity-Yoder M.E.
        • Insel K.C.
        • Crane T.E.
        • Pace T.W.W.
        Diet quality and disease activity in rheumatoid arthritis.
        Nutrition and Health. 2021; 1–10
        • Minamino H.
        • Katsushima M.
        • Hashimoto M.
        • Fujita Y.
        • Torii M.
        • Ikeda K.
        • Inagaki N.
        Influence of dietary habits on depression among patients with rheumatoid arthritis: A cross-sectional study using KURAMA cohort database.
        Plos One. 2021; 1–15
        • Nezamoleslami S.
        • Ghiasvand R.
        • Feizi A.
        • Salesi M.
        • Pourmasoumi M.
        The relationship between dietary patterns and rheumatoid arthritis: A case–control study.
        Nutrition & Metabolism. 2020; 17: 1-8
        • Ng J.K.
        • Huang Y.K.
        • Tung H.C.
        • Hsu B.B.
        • Wu H.C.
        • Lu C.M.
        • Lai S.N.
        Risk factors, including different biologics, associated with depression and anxiety in patients with rheumatoid arthritis: A cross-sectional observational study.
        Clinical Rheumatology. 2020; 39: 737-746
        • Özkoca Ö.
        Assessment of the relationship eating attitudes, perceived social support, psychopathology and treatment motivation on obese people.
        Işık University, 2018 (Master Thesis)
        • Peterson S.
        • Piercy J.
        • Blackburn S.
        • Sullivan E.
        • Karyekar S.C.
        • Li N.
        The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis.
        BMC Rheumatology. 2019; 28, 3
        • Pincus T.
        • Summey J.A.
        • Soraci Jr., S.A.
        • Wallston K.A.
        • Hummon N.P.
        Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire.
        Arthritis & Rheumatology. 1983; 26: 1346-1353
        • Prevoo M.L.L.
        • van ’t Hof M.A.
        • Kuper H.H.
        • Leeuwen van M.A.
        • Putte de van B.L.
        • Riel van L.P.
        Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.
        Arthritis & Rheumatology. 1995; 38: 44-48
        • Qin B.
        • Yang M.
        • Fu H.
        • Ma N.
        • Wei T.
        • Tang Q.
        • Zhong R.
        Body mass index and the risk of rheumatoid arthritis: A systematic review and dose-response meta-analysis.
        Arthritis Research and Therapy. 2015; 17: 86
        • Raad T.
        • George E.
        • Griffin A.
        • Larkin L.
        • Fraser A.
        • Kennedy N.
        • Tierney A.
        A randomised controlled trial of a Mediterranean dietary ıntervention for adults with rheumatoid arthritis (MEDRA): Study protocol.
        Contemporary Clinical Trials Communications. 2022; 28100919
        • Rojop-Juarez E.I.
        • Rosales-Nolasco A.G.
        • Mandujano-Perez A.
        • Castro-Gonzalez B.T.
        • Zrate-Tovilla A.C.
        • Narvaez-Lopez L.M.
        • Fresan A.
        Prevalence for and factors associated with depression and anxiety symptoms in Mexican patients with rheumatoid arthritis.
        Journal of Clinical Rheumatology. 2020; 26: 111-115
        • Rondanelli M.
        • Perdoni F.
        • Peroni G.
        • Caporali R.
        • Gasparri C.
        • Riva A.
        • Rigon C.
        Ideal food pyramid for patients with rheumatoid arthritis: A narrative review.
        Clinical Nutrition. 2022; 40: 1-29
        • Savaşır I.
        • Erol N.
        Anorexia neurosa symptoms ındex.
        Turkish Journal of Psychology. 1989; 7: 19-25
        • Standley N.K.
        • Gjertson I.
        • Winkvist A.
        • Lindqvist M.H.
        Dietary habits of women with rheumatoid arthritis differ from that of women without the disease: Results from a population-based study.
        Journal of Rheumatic Diseases and Treatment. 2019; 5: 1-9
        • Switała A.
        • Wyszyńska J.
        • Czerwińska K.
        • Dereń K.
        • Podgórska-Bednarz J.
        • Guzik A.
        Association between body mass and physical activity with quality of life in patients with rheumatoid arthritis.
        European Journal of Clinical and Experimental Medicine. 2018; 15: 200-205
        • Tanski W.
        • Wojciga J.
        • Polanska-Jankowska B.
        Association between malnutrition and quality of life in elderly patients with rheumatoid arthritis.
        Nutrients. 2021; 13: 1259
        • Taş İ.H.
        • Ertekin H.
        • Yıldızoğlu A.Ç.
        • Ertekin H.Y.
        The relationship of eating attitudes and body composition to the severity of depression in patients with major depressive disorder.
        Kafkas Journal of Medical Sciences. 2019; 9: 39-45
        • Taşpınar Ö.
        • Aydın T.
        • Keskin Y.
        • Demir E.S.
        • Kepekçi M.
        • Kızıltan H.
        • Mutluer S.A.
        Diet habits of rheumatoid arthritis patients in Turkish Society and relationship between diet habits and rheumatoid arthritis activity.
        Panacea Journal of Pharmacy and Pharmaceutical Sciences. 2016; 5: 16-23
        • Tayfur N.S.
        • Evrensel A.
        Investigation of the relationships between eating attitudes, body image and depression among Turkish university students.
        Rivista di Psichiatria. 2020; 55: 90-97
        • Tiosano S.
        • Yavne Y.
        • Vatad A.
        • Langevitz P.
        • Lidar M.
        • Tishler M.
        • Gurman B.A.
        The impact of tocilizumab on anxiety and depression in patients with rheumatoid arthritis.
        European Journal of Clinical Investigation. 2020; 50e13268
        • Turkish Society of Endocrinology and Metabolism(TEMD)
        Obesity Diagnosis and Treatment Guide.
        6th Edition. 2018: 11-112 (Ankara: Miki Matbaacilik San. and Tic. Ltd. Sti)
        • Ulusoy M.
        • Şahin N.
        • Erkmen H.
        Turkish version of Beck Anxiety inventory: Psychometric properties.
        Journal of Cognitive Psychotherapy: An international Quarterly. 1998; 12: 163-172
        • Ünal E.
        • Arın G.
        • Karaca N.B.
        Development of a quality of life scale for patients with rheumatism: Creation of an item pool.
        Journal of Exercise Therapy and Rehabilitation. 2017; 4: 67-75
        • Usubini A.G.
        • Varallo G.
        • Giusti E.M.
        • Cattivelli R.
        • Granese V.
        • Consoli S.
        • Castelnuovo G.
        The mediating role of psychological ınflexibility in the relationship between anxiety, depression, and emotional eating in adult ındividuals with obesity.
        Frontiers in Psychology. 2022; 13861341
        • van Vilsteren M.
        • Boot C.R.L.
        • Knol D.L.
        • van Schaardenburg D.
        • Voskuyl A.E.
        • Steenbeek R.
        • Anema J.R.
        Productivity at work and quality of life in patients with rheumatoid arthritis.
        BMC Musculoskeletal Disorders. 2015; 16: 1-9
        • Van Wilder L.
        • Pype P.
        • Mertens F.
        • Rammant E.
        • Clays E.
        • Devleesschauwer B.
        • De Smedt D.
        Living with a chronic disease: Insights from patients with a low socioeconomic status.
        BMC Family Medicine. 2021; 22: 1-11
        • Yıldırım A.
        • Hacıhasanoğlu Aşılar R.
        • Karakurt P.
        • Çapık C.
        • Kasımoğlu N.
        Examination of the relationship among depressive symptom, loneliness and eating attitudes in university students with sociodemographic characteristics.
        Turkish Journal of Family Medicine and Primary Care. 2018; 12: 264-274
        • Zabsonre T.J.W.
        • Kabore F.
        • Nanema D.
        • Savadogo B.
        • Drave A.
        • Sompougdou C.
        • Faso B.
        frequency and factors associated with depression in rheumatoid arthritis in African black patients: Case-control study.
        Open Journal of Rheumatology and Autoimmune Diseases. 2019; 9: 35-41
        • Zhang L.
        • Xia Y.
        • Zhang Q.
        • Fu T.
        • Yin R.
        • Guo G.
        • Gu Z.
        The correlations of socioeconomic status, disease activity, quality of life, and depression/anxiety in Chinese patients with rheumatoid arthritis.
        Psychology, Health and Medicine. 2017; 22: 28-36