943 – Mental disorders in rheumatoid arthritis patients: stress factors and pain relations

Abstract

To analyze the prevalence of stress factors, mental disorders (MD) and their influence on pain in rheumatoid arthritis (RA) patients (pts). 125 RA-pts with a mean age of 47.4±1.01 yrs and disease duration of 138.4±10.1 month were enrolled. The RA disease activity was assessed by DAS-28. BPI was used for pain severity assessment. MD were diagnosed in accordance with ICD-10 criteria. MD were diagnosed in 117 (93.6%) RA pts: depressive episode (n=46,39%) (RDD incl. - 27%); dysthymia (n=41,35%), adjustmend disorders(n=21,18%); GAD (n=9,8%). Mild cognitive disorder was diagnosed in 83 (66.4%) of RA-pts. The significant stress factors preceding RA manifestation were found in 97 (77.6%) cases; in 76 (61%) - stress factors preceded RA exacerbation. Significant chronic stress events during childhood had 84 (67.2%) patients. Patients with MD more often (p< 0.05) had the fourth X-ray stage of RA and maximal stage of functional disability. Mean age of the first prednisone intake was significantly higher (p< 0.05) in patients with MD. RA-pts with severe pain (=7 BPI-points) were 3 times more likely to have depressive disorder than RA-pts with mild pain (1-4 BPI-point) (48.6% vs 15.6%, ?R=3.1, 95% CI=0.97-9.93, ?=0.004). The results have shown high prevalence of stress related MD in RA-pts and confirm the stress-diathesis approach to pathogenesis of MD in rheumatic disease. The RA patients group with MD had high level of pain severity, X-ray stage and functional disability in comparison with patients without MD.