AB0289 DEPRESSION AND METABOLIC DISORDERS PREVENT REMISSION IN RHEUMATOID ARTHRITIS

Abstract

BackgroundEpidemiological data and clinical observations suggest an increased risk of depressive disorders in rheumatoid arthritis (RA) patients with metabolic syndrome (MS) [1, 2].ObjectivesTo study the prevalence of depressive symptoms depending on the presence of MS components in RA patients and to evaluate their combined effect on achieving remission of RA.Methods100 RA patients aged 18 to 69 years old (91% women; mean duration of disease 9 [3.5;15] years; body mass index (BMI) 28.8 [IQR 25.1-32.8]) were examined. MS was confirmed in RA patients with three or more harmonized National Cholesterol Education Program/ Adult Treatment Panel III (NCEP/ATPIII; 2004) criteria. RA patients were assigned a binary MS score (“yes/no”) and a categorical MS score (from 0 to 5 criteria) was calculated. The severity of depression in patients with RA was determined using the Beck Depression Inventory (BDI).Results46% of RA patients met the criteria for MS. The presence of three categorical signs of MS was noted in 26%, four - in 16% and of all five signs - in 4% of cases. The combination of elevated fasting glucose, elevated triglycerides (TG), and decreased high-density lipoproteins (HDL) was the most frequent (19.6%; 9/46). The combination of the four MS criteria (increased waist circumference (WC), elevated TG, decreased HDL, and arterial hypertension) occurred in 17.4% (8/46) of cases. RA patients with MS had more severe systemic inflammation (C-reactive protein 9.3[3.9; 23.1] versus 3.35[2.3; 12.0] mg/L, p=0.028), higher levels of TG (p=0.001) and total cholesterol (p=0.003), and higher BMI (p=0.018) and WC (p=0.007).Depression scores of BDI ≥10 were noted in 64 RA patients: 26% were mild, 28% were moderate and 10% were severe. Symptoms of depression were more frequent in RA patients with longer duration (β=0.25, p=0.012) and high activity (β=0.37; p=0.001) of the disease. There were statistically significant differences in the incidence of depression (BDI ≥10 points) depending on the absence or presence of MS in RA patients (Phi-square=0.42; association coefficient φ=0.65). When comparing groups of RA patients stratified by the presence of MS, significant differences in the severity of depressive disorders according to BDI were found (RA without MS: 8,35 ± 5,1 points; RA with MS: 23,6 ± 12,8 points, p < 0,001). In RA patients without MS, only mild (26%) and moderate (9.3%) depression were detected. In RA patients with MS, depressive symptoms from mild to severe were present in almost equal poportions. Two-factor analysis of variance showed no significant effect of BDI and MS on DAS28-ESR activity in RA patients (p>0.05). The presence of MS had a significant effect on BDI depression (p<0.001), and there was no relationship between MS and the degree of disease activity (p=0.33).Re-examination (6-7 months later) of patients with initially moderate RA activity (n=58) revealed that remission of the disease was not achieved in 25% of patients from the group with no signs of depression and MS. In the group of RA patients with MS and BDI ≥10 there were almost 2.5 times more cases of deterioration (63.3%) (χ2 with Yates correction = 4.7, p=0.03).ConclusionProgression of depression against the background of marked metabolic disorders can lead to a decrease of RA patients’ quality of life and complicate disease prognosis [3, 4, 5]. This requires an early multidisciplinary treatment and increased knowledge of the risks associated with depression and MS among health care professionals and patients. Identification and correction of symptoms of depression and MS in RA patients should be a part of the optimal patient care.