Over half (63%) of patients with rheumatoid arthritis (RA) also suffer from psychiatric disorders, with the majority of these (87%) occurring in the depressive spectrum, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Interestingly, over half (52%) of the patients studied indicated that they had experienced stress events before the onset of their RA.
The study also revealed a number of other interesting findings about the emotional burden of RA:
- Cognitive dysfunction was diagnosed in 23% of patients, with 16% of this attributed to depression
- A third (33%) suffered from sleep disorders
- Those with depression also exhibited more severe RA (measured by X-ray), greater functional insufficiency and pain, as well as having received less aggressive treatment than patients without depression. (No significant differences in age, duration of illness, gender or DAS28* scores were noted between the two groups)
- Significantly, cognitive impairments were found more often (p=0.02) in patients older than 50 years (39% vs. 9%)
- The age of the first prednisone intake was significantly higher (p<0.05) in patients with depression compared to those without (48 vs. 30 years)
Dr Tatiana Lisitsyna from the State Institute of Rheumatology RAMS, Russian Federation, who conducted the study, said: "Psychiatric disorders are a very common comorbidity for people with RA, and they tend to be stress-related and associated with disease activity and chronic pain. Evaluating and addressing the mental health of those with RA should be a regular feature of rheumatology practice to improve quality of life and reduce the potentially distressing psychological burden of RA."
In the study, the disease activity of 75 patients with American College of Rheumatology (ACR) defined RA (96% female, median age 52 years (46-55), median disease duration 12 years (4-22) was assessed using DAS28* with a median score of 4.98 (3.71 - 6.4). Median prednisone intake duration was 34 months (3-72) and 80% of patients were taking DMARDs (49% methotrexate; 23% leflunomide). Using the Brief Pain Inventory (BPI) scale to assess pain, 74% were considered to have either severe (7-10 points) or moderate (5-6 points) pain.
Psychiatric disorders were diagnosed in accordance with the ICD-10 (International Classification of Disease) scale, and other psychiatric and psychological scales used included: the Hospital Anxiety and Depression Scale for screening, the Hamilton Anxiety Rating Scale and the Montgomery-Asberg Depression Rating Scale. Projective psychological methods were employed for evaluation of cognitive function.
* DAS28 (Disease Activity Score) is an index used by physicians to measure how active an individual's RA is. It assesses number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient's 'global assessment of global health'. A higher score indicates more active disease.
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