Abstract
ObjectivesTo investigate the prevalence of depressive symptoms in rheumatoid arthritis (RA) patients using two previously validated questionnaires in a large patient sample, and to evaluate depressive symptoms in the context of clinical characteristics (e.g. remission of disease) and patient-reported impact of disease.MethodsIn this cross-sectional study, the previously validated Patient Health Questionnaire (PHQ-9) and Beck-Depression Inventory II (BDI-II) were used to assess the extent of depressive symptoms in RA patients. Demographic background, RA disease activity score (DAS28), RA impact of disease (RAID) score, comorbidities, anti-rheumatic therapy and antidepressive treatment, were recorded. Cut-off values for depressive symptomatology were PHQ-9 ≥5 or BDI-II ≥14 for mild depressive symptoms or worse and PHQ-9 ≥ 10 or BDI-II ≥ 20 for moderate depressive symptoms or worse. Prevalence of depressive symptomatology was derived by frequency analysis while factors independently associated with depressive symptomatology were investigated by using multiple logistic regression analyses. Ethics committee approval was obtained, and all patients provided written informed consent before participation.ResultsIn 1004 RA-patients (75.1% female, mean±SD age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28 (ESR): 2.5±1.2), the prevalence of depressive symptoms was 55.4% (mild or worse) and 22.8% (moderate or worse). Characteristics independently associated with depressive symptomatology were: age <60 years (OR = 1.78), RAID score >2 (OR = 10.54) and presence of chronic pain (OR = 3.25). Of patients classified as having depressive symptoms, only 11.7% were receiving anti-depressive therapy.ConclusionsMild and moderate depressive symptoms were common in RA patients according to validated tools. In routine clinical practice, screening for depression with corresponding follow-up procedures is as relevant as incorporating these results with patient-reported outcomes (e.g. symptom state), because the mere assessment of clinical disease activity does not sufficiently reflect the prevalence of depressive symptoms.Clinical trial registration numberThis study is registered in the Deutsches Register Klinischer Studien (DRKS00003231) and ClinicalTrials.gov (NCT02485483).
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the musculoskeletal system that leads to pain, swelling and progressive joint destruction via increased activity of proinflammatory cytokines [1]
Characteristics independently associated with depressive symptomatology were: age 2 (OR = 10.54) and presence of chronic pain (OR = 3.25)
Mild and moderate depressive symptoms were common in RA patients according to validated tools
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the musculoskeletal system that leads to pain, swelling and progressive joint destruction via increased activity of proinflammatory cytokines [1]. A variety of conventional and biological disease modifying anti-rheumatic drugs are available to control disease activity in RA, the disease is still challenging and usually requires life-long treatment It is associated with a substantial reduction of overall physical and emotional well-being due to articular symptoms including pain and loss of physical function and as a result of fatigue and impaired quality of sleep [1, 2]. This disease burden can affect the patient’s quality of life and socioeconomic outcomes including workplace absenteeism and presenteeism (low workplace productivity) [3,4,5]. Dougados et al found adherence to PLOS ONE policies on sharing data and materials
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