Abstract
IntroductionDepression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity. This study aims to estimate, in a large cohort of Italian patients with RA, the prevalence of depression and to investigate the clinical correlates of depression in terms of disease activity and disability.MethodsThis is a cross-sectional study enrolling 490 outpatients with RA (80% female, mean age 59.5). The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence of depression with a cut-off of 11. We collected data about disease activity and disability with DAS28, TJC-68, PhGA, PGA, VAS, DAS28, SDAI, CDAI and HAQ.ResultsPrevalence of depression was 14.3% (95% CI: 11-17%). Depressed patients, when compared with not depressed ones, were found to have higher scores for TJC-68 (p = 0.011), PhGA (p = 0.001), PGA (p = 0.001), VAS (p = 0.001), DAS28 (p = 0.007), SDAI (p = 0.001), CDAI (p = 0.001) and HAQ (p = 0.001). Out of the 70 depressed patients, 30 subjects, already known to be depressed in the past, were still depressed at the time of the assessment, with only 11 (15.7%) under antidepressants. A multivariate analysis showed that male sex, higher PGA score, use of antidepressants and higher HAQ score were significantly associated with an increased risk of depression.ConclusionsOur study shows that depression is common in RA and may affect its activity mainly via an alteration in the perception of the disease. Although its important implications, depression is still under-diagnosed and its management is inadequate.
Highlights
Depression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity
We found that the prevalence of depression was 14.3%
This study evaluates the prevalence of depression and its clinical correlates in terms of disease activity and disability in a large sample of patients affected by RA
Summary
Depression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity. Rheumatoid arthritis (RA) is a chronic inflammatory disease with a prevalence of 0.5–1% in Europe, with the lower values in southern countries [1]. It primarily involves peripheral joints, damaging cartilages and. The presence of depression has been associated with increased pain perception [4], increased level of physical disability [7], enhanced health care costs [6], and greater mortality [4] It has been demonstrated a significant association between persistent depression and high continuous disease activity, measured by the Clinical Disease Activity Index (CDAI) [8]. Most of the activity scores commonly used in rheumatology are based on subjective measures that may be affected by the psychological status [9] and may further influence the assessment of disease activity
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