63 percent of RA patients suffer psychiatric disorders, with depressive spectrum conditions most likely

Jun 12, 2009

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. 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: " 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 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.

Source: European League Against Rheumatism

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User comments : 2

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jim444
5 / 5 (1) Jun 13, 2009
Simply put ..again if your sick then you get fed up..period.

You do not need a study to tell you this....and if a Doc has not already appreciated this fact then he shouldnt be practising.

The point here is..we need to focus on care..highlight to everyone in the world how tough on the patients these diseases are..and push for better treatments..

Invariably a heart patient gets better care than an RA patient..it seems to be the rule that..if we cant fix the thing you have you then we wont put so much effort in caring for you...so it is for all Autoimmune diseases...

Id rather a study put money on a novel treatment than waste the time the effort and money on something we already know very well.
Nan2
not rated yet Jun 14, 2009
^Indeed. For those who suffer chronic and progressive disease states its a given. Its sad that this is overlooked and remains largely unreported, untreated as specialists focus solely on a portion of the disease aspect, treatment remains ad hoc and dependent on individual physician approaches to what is chronic care.

Physicians are likely frustrated too as their treatment toolboxes are limited as are avenues to address symptom-relief beyond treating the core disease state. Addressing anxiety/depression could improve the quality of life for those who must deal daily with their conditions which often includes limiting fatigue and pain for which assessment tools are too narrow as auto-immune diseases are systemic diseases with layers of issues. In RA, for example, only the top layer of the disease state is assessed.

The anxiety/depression isn't merely a self-pitying state, its reactive to a frustrating reality which remains marginalized in longer term management and a comprehensive approach to care as the above poster points out. Insurers see no merit in more comprehensive care; therefore, it isn't offered or paid for.

Stress and stress responses are measurable in auto-immune disease activity be it emotional or physical. It is an area of study overlooked and is overlooked in disease management at the practice level.

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