Dr. Katz’s research has redefined disability in the context of rheumatic disease and provided a more comprehensive view of disability than in the past. Dr. Katz says that the seeds of this work were planted while she was in conversation with clinicians who would describe two patients who appeared to be in similar condition and at a similar stage of their disease, but whose lives were very different. She says she decided to start her investigation by determining what each group of patients was doing differently. She found that life looked bleaker to those who felt they couldn’t do the things for themselves that mattered to them, such as caring for their children or grandkids, walking with friends, or doing whatever gave spice to their lives.
How is this information valuable in a clinical setting? Dr. Katz believes that one starts by asking patients, “Can you do the things you want to do?” If the patient answers, “No,” you have found your starting point, she says. It may not be possible to undo existing damage, but there may be different ways to deal with damage. A medication may lead to symptom improvement. Patients can get help resetting priorities and finding activity replacements. For example, a patient may no longer be able to walk with friends, but she could still meet them for coffee afterwards and get the benefits of the social interaction. These tasks require mental flexibility, which may take some outside help, she says. The stakes are high, because her research has found that the loss of these activities increases the risk of depression. She describes a dangerous spiral that starts with the loss of the activity, followed by depression, which lowers the ability to cope and reframe problems. Interrupting the process is crucial. Depression treatment may give the patient better coping resources, or improving functioning and finding new outlets may lessen the burden of the illness. The message: It’s important to look at a bigger picture and set the bar higher than opening jars or taking a bath when assessing disability. With physician time at a premium, Dr. Katz looks for more integration of care among physicians, nurses, and various types of therapists.
Q: What have you learned in your work with patients with other chronic illnesses, such as adult asthma and chronic obstructive pulmonary disease?
A: We find the same relationships. The risk for depression increases when patients with these disorders lose the ability to do what’s important to them. It’s consistent with our findings in people with lupus and RA.
