Depression In Rheumatoid Arthritis Patients Research Articles

A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

Association between laughter, frailty, and depression in rheumatoid arthritis patients.

This study aimed to determine whether there are associations between laughter, disease activity, frailty, and depression in rheumatoid arthritis (RA) patients. A total of 240 patients were included in this prospective cohort study on frailty in RA patients between March 2021 and June 2022. Patients were divided into the following four groups according to the frequency of laughter: "almost every day," "1-5 days per week," "1-3 days per month," and "never or almost never." Patient characteristics were compared among the four groups by analysis of variance. Factors associated with laughter were identified by multivariable logistic analysis. The mean 28-joint Disease Activity Score using CRP was 1.91, with 70.7% of patients in remission and 12.6% in low disease activity. For the "almost every day" (42.5% of patients), "1-5 days per week" (40.0%), "1-3 days per month" (11.3%), and "never or almost never" (6.3%) groups, scores of the Kihon Checklist (KCL) for assessing frailty status were 3.5, 4.6, 7.3, and 8.1 (p < .001), respectively, and scores of the Beck Depression Inventory (BDI-II) were 8.4, 10.7, 15.1, and 16.5 (p < .001), respectively. Multivariable analysis revealed that KCL (OR: 0.81, 95% CI: 0.73-0.90) and BDI-II (OR: 0.91, 95% CI: 0.86-0.95) scores were independently associated with the frequency of laughter. Frailty and depression were associated with laughter in RA patients with controlled disease activity. Interventions aimed at not only disease activity control but also frailty prevention may lead to a life filled with laughter.

Are diet and exercise associated with depression in rheumatoid arthritis patients?

Abstract Background Although depression is a common comorbidity of rheumatoid arthritis (RA), little is known about a potential treatment strategy. Current studies of dietary improvement for depression have recently emerged in the general population, but have hardly any coverage in RA. Also, less exercise increases the number of people experiencing depression, and current studies showed that most RA patients are physically inactive. Thus, our study aimed to identify the potential factors associated with depression in RA patients. Methods We included 157 RA patients (84.7% female; mean age 56.43±13.9 years; mean disease duration 19.53±9.54 years). All participants completed the General Health Questionnaire - 28, the Visual Analogue Scale Pain, the 36-item Short Form Health Survey, the Physical Activity Scale, and the Food Frequency Questionnaire. Correlations and multiple linear regressions were used to analyse the data. Results Bivariate analyses showed a significant association between disease activity (.25; p ≤ 0.01), functional disability (.22; p ≤ 0.01), pain (.35; p ≤ 0.001), fatigue (-.45; p ≤ 0.001), physical inactivity (-.19; p ≤ 0.05), frequent consumption of fried foods (-.22; p ≤ 0.01) and depression. No other foods were associated with depression in RA. The multiple regression analyses showed that disease activity, fatigue, and fried foods consumption were significantly associated with depression in the final model. However, the association between physical activity and depression was no longer significant using multivariate models. Explained variance in the final regression model was 27.6%. Conclusions It appears that frequent consumption of fried foods is associated with depression in RA when controlled for sociodemographic and clinical variables. Further research on specific dietary habits and underlying mechanisms in the gut-brain axis may help to develop treatment options for the prevention of psychological distress in RA. (Grant: VEGA: 1/0748/22; APVV-15-0719) Key messages • Non-pharmacological intervention for reducing depression should target the patient's diet. • Frequent consumption of fried food may influence depression more significantly than physical inactivity.

Anxiety and depression in rheumatoid arthritis patients: prevalence, risk factors and consistency between the Hospital Anxiety and Depression Scale and Zung's Self-rating Anxiety Scale/Depression Scale.

The aim was to explore the prevalence and independent risk factors for anxiety and depression in RA patients and to assess the consistency between the hospital anxiety and depression scale (HADS) and Zung's self-rating anxiety scale/depression scale (SAS/SDS). In total, 160 RA patients and 60 healthy controls (HCs) were enrolled consecutively, and HADS and SAS/SDS were completed. The HADS-defined anxiety rate, HADS-defined depression rate, SAS-defined anxiety rate and SDS-defined depression rate were 36.9, 36.3, 29.4 and 29.4%, respectively, in RA patients, all of which were much higher in RA patients than in HCs (all P < 0.001). A relatively high consistency was observed between HADS-defined anxiety and SAS-defined anxiety (κ = 0.551, P < 0.001) and between HADS-defined depression and SDS-defined depression (κ = 0.563, P < 0.001) in RA patients. Interestingly, screened by multivariate logistic regression analyses, single/divorced/widowed marital status, swollen joint count, disease duration, ESR, physician's global assessment (PhGA) and DAS28 were independently correlated with HADS-defined or SAS-defined anxiety risk in RA patients; meanwhile, female biological sex, single/divorced/widowed marital status, rural location, disease duration, PhGA and DAS28 were independently associated with HADS-defined or SDS-defined depression risk in RA patients. Anxiety and depression are highly prevalent in RA patients and are independently correlated with single/divorced/widowed marital status and higher disease activity. In addition, the HADS presents a high consistency with the SAS/SDS with many fewer questions, which might be more suitable for long-term assessment of RA.

Effect of Moringa oleifera Leaf Extracts on Depression in Rheumatoid Arthritis Patients

Introduction: Depression is a mental disorder that is increasingly common nowadays. It can emerge as morbidity in chronic diseases such as rheumatoid arthritis (RA). The leaf extract of Moringa oleifera (MO) has shown to be a complementary therapy in depression, besides its anti-inflammatory role. This study aimed to evaluate the effect of MO leaf extract on Depression in RA patients. Methods: This quasi-experimental study with a pretest-posttest control group design comprised 32 RA patients. The participants were divided into the control (n = 16) and intervention (n = 16) groups. The intervention group received two MO leaf extract-containing capsules b.i.d. for 28 days. The depression was evaluated by Beck Depression Inventory (BDI-II) and serum cortisol test. Statistical analyses used both paired and unpaired t-tests. Results: The posttest means comparison of BDI-II and serum cortisol showed a significant difference between groups (p = 0.031 and p = 0.015, respectively). The pretest-posttest difference within the control group did not show significant improvement in BDI-II and serum cortisol (p = 0.076 and p = 0.106). Meanwhile, significant BDI-II and serum cortisol improvement were found in the intervention group (p = 0.003 and p = 0.048, respectively). Conclusion: MO leaf extract reduces depression in RA patients based on BDI-II and serum cortisol assessment.

Association between Proinflammatory Cytokines and Anxiety and Depression Symptoms in Rheumatoid Arthritis Patients: A Cross-sectional Study.

Rheumatoid arthritis (RA) patients have a greater prevalence of anxiety and depression. Proinflammatory cytokines are elevated in RA. We aim to evaluate the association between systemic inflammation in RA and anxiety and depression. There were 31 RA patients, 16 with active disease activity and 15 in remission state; they were assessed using the Hospital Anxiety and Depression Scale and for RA disease activity using Disease Activity Score of 28 joints (DAS28) - CRP (C-reactive protein). Serum proinflammatory cytokines were measured, including interleukin (IL)-6, IL-17, and Tumour Necrosis Factor-alpha (TNF-α). Among 31 patients, ten patients showed anxiety symptoms, 19 patients showed depression symptoms, and two displayed mixed symptoms. Serum TNF-α levels were significantly higher in active disease than in the remission group (p-value 0.006). There was no association or correlation between proinflammatory cytokines to anxiety and depression symptoms in the active disease and remission groups. This suggests that other factors besides disease activity and state of systemic inflammation may cause anxiety and depression in RA patients.

E070 How well is the mental health of rheumatoid arthritis patients assessed in the routine rheumatology clinic?

Abstract Background/Aims All patients with rheumatoid arthritis (RA) should have an annual review appointment (NG100). This should involve monitoring for the development of co-morbidities including depression and offer psychological interventions where appropriate. The current literature suggests that the prevalence of depression in RA patients is as high as 38.8% and is associated with poorer disease outcomes. We undertook a retrospective record review of our RA cohort to assess adherence to the NICE RA guidance, including mental health monitoring specifically. Methods 340 patients were selected using convenience sampling from the total population of 3400. The letters 12 months prior to an identified appointment in January 2019 were reviewed looking at: age, gender, DAS28 score, other long-term conditions, whether mental health was discussed that year, and who initiated the conversation. Data was collected, reviewed, and analysed by HC, JE and AA. Results The mean age was 65.9 (SD = 12.3), the female to male ratio was 2.3:1 (70% female), the median DAS28 score was 2.94 (IQR=2.01), and the median VAS score was 40.0 (IQR=63.5). 73.2% (n = 249/340) had at least one other documented co-morbidity, 12.1% (n = 41/340) had a documented chronic pain syndrome, 3.5% (n = 12/340) had a documented mental health diagnosis. 7.9% (n = 27/340) of patients discussed mental health at their appointment; this increased to 58.3% (n = 7/12) of the patients with a known mental health diagnosis. Mental health discussions were initiated by the clinician 18.5% (n = 5/27) of the time, and by the patient 81.5% (n = 22/27) of the time. Of the 5 patients who were asked directly about their mental health: 100% (n = 5/5) were female, the mean age was 63.8, the median DAS28 and VAS scores were lower than the overall cohort at 2.56 (IQR=0.93) and 28.5 (IQR=15.3) respectively. Of the 22 patients who initiated a discussion about their mental health: 72.7% (n = 16/22) were female, the mean age was 62.3, the median DAS28 and VAS scores were higher than the overall cohort at 3.55 (IQR=2.45) and 60.0 (IQR=51.3) respectively. Of the 27 patients who had a mental health discussion: 76.0% (n = 19/27) had another documented co-morbidity, 22.2% (n = 6/27) had a documented chronic pain syndrome, and 25.9% (n = 7/27) had a mental health diagnosis. Conclusion Mental health problems may be under-recognised amongst our patients; this may reflect lack of documentation or limited routine screening. The majority of conversations about mental health appear to be initiated by patients. Patients with lower disease activity appear to be more likely to have mental health discussions. The study is limited by small numbers, and further research in this area would be beneficial. Disclosure H. Cooney: None. J. Ellis: None. B. Mulhearn: None. A. Allard: None.

Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study.

Anxiety and depression are common psychological problems in rheumatoid arthritis (RA) patients. However, few effective nursing intervention models have been designed specifically to improve anxiety and depression in RA patients. Solution-focused approach (SFA) is an effective intervention method for psychosocial issues. There have been no studies involving SFA yet in RA patients. This study investigated the effects of SFA-based nursing intervention on anxiety and depression in RA patients. A quasi-experimental study using a convenience sampling of RA patients was conducted. The 48 RA patients were divided into the control group (n = 24) and the experimental group (n = 24). The control group received routine nursing intervention, while the experimental group received SFA-based nursing intervention. The scores on the self-rating anxiety scale (SAS), self-rating depression scale (SDS), arthritis self-efficacy scale-8 (ASES-8), and questionnaire on patient satisfaction with nursing care were collected before and after nursing interventions. Between-Group Comparison: Before the nursing intervention, there was no statistically significant difference in the SDS, SAS, and ASES-8 scores between the two groups (p > 0.05). However, after the nursing intervention, the SDS and SAS scores of the experimental group were statistically significantly lower than those of the control group (p < 0.05). In contrast, the ASES-8 score of the experimental group was statistically significantly higher than that of the control group (p < 0.05). In addition, patient satisfaction with nursing care of the experimental group was better than that of the control group (p > 0.05). Within-Group Comparison: There was no statistically significant difference in the SDS, SAS, and ASES-8 scores in the control group before and after routine nursing intervention (p > 0.05). However, in the experimental group, the SDS and SAS scores before SFA-based nursing intervention were statistically significantly higher than those after SFA nursing intervention (p < 0.05), and the ASES-8 score before SFA-based nursing intervention was considerably lower than that after SFA nursing intervention (p < 0.05). SFA-based nursing intervention can effectively improve anxiety, depression, and arthritis self-efficacy of RA patients. This study broadens clinical psychological nursing intervention models for RA patients. SFA may be an effective nursing model for various psychosocial problems in the current medical context.

The Anxiety and Depression in Rheumatoid Arthritis Patients Treating with Disease-Modifying Anti-Rheumatic Drugs during the COVID-19 Pandemic.

Anxiety and depression are associated with the risk of illness, presence of physical symptoms, and poor health in the COVID-19 epidemic. Our aim is to assess the severity of anxiety and depression in rheumatoid arthritis (RA) patients treated with disease-modifying anti-rheumatic drugs during the COVID-19 pandemic. The study is a longitudinal, hospital-based survey study including 102 RA patients receiving disease-modifying anti-rheumatic drugs with a mean of 55,2±11,9 years. Demographic data, educational status, marital status, employment status, economic status, patients with psychiatric disorders (with the use of prescribed medication for treatment), and medications were recorded. The severity of depression and anxiety were evaluated with the Beck Anxiety and Depression Inventory at the first and second visit of the follow-up during the pandemic period. The mean Beck depression inventory score was found to be higher in the conventional synthetic DMARDs group than in biological DMARDs (12,1±8,2 vs 11,6±9,2, p=0,554). 46 (65,7%) had mild to severe anxiety symptoms in RA patients treated with conventional synthetic DMARDs, on the first visit. There was no significant difference in anxiety and depression status between the first and second visits. The difference in anxiety and depression symptoms between RA patients receiving conventional synthetic and biological DMARDs does not attain statistical significance. Also, no significant differences were found in anxiety and depression scores in the comparisons for gender, education, marital, working, and economic status. The severity of depression and anxiety were higher in RA patients receiving conventional synthetic DMARDs and biological DMARDs during the COVID-19 pandemic. Also, RA patients are likely to experience anxiety and depression during the period of the pandemic.

The prevalence and the effect of interferon -γ in the comorbidity of rheumatoid arthritis and depression

BackgroundDepression is the most common comorbidities associated with rheumatoid arthritis (RA). We aimed to explore the mechanism of association between RA and depression. Methods120 subjects were enrolled and depression was diagnosed and assessed using DSM-5 and 24-item version of Hamilton Depression Scale. Pain intensity and joint function in patients with RA were assessed using the visual analog scale (VAS) and health assessment questionnaire (HAQ). Serum levels of interferon-gamma (IFN-γ), indoleamine 2,3-dioxygenase (IDO), kynurenine (KYN), tryptophan (TRP), and quinolinic acid (QUIN)were detected. In animal experiments, K/BxN mice with RA-like phenotype was used and depressive behavior was observed. The protein expression level of N-methyl -D- aspartate receptor 2B (NR2B) in the hippocampus was detected. ResultsIn this study, 36.67 % of patients with RA also had depression. The working status, month family income, tender joint count, the VAS and HAQ score were the main factors influencing the depression in RA patients. HAQ score was found to be an independent risk factor for depression in RA. Serum IDO, IFN-γ, KYN were increased and TRP contents were decreased in RA group. K/BxN mice with RA-like phenotype showed depressive behavior. However, injection of IFN-γ neutralizing antibody could inhibit kynurenine pathway and reverse the depressive behavior in mice. The levels of QUIN in the neurotoxic metabolic pathway were increased and N-methyl -D- aspartate receptors (NMDAR) were activated, which may be the mechanism behind the onset of depression. ConclusionsFrom clinical and preclinical aspects, the occurrence of depression in RA was explored and the related mechanism was revealed.

Needle-Warming Moxibustion plus Multirehabilitation Training to Improve Quality of Life and Functional Mobility of Patients with Rheumatoid Arthritis after Medication

Objective Patients treated with medication for rheumatoid arthritis (RA) often improve but continue to have active diseases. The study aims to investigate whether needle-warming moxibustion (NWM) plus multirehabilitation training can improve quality of life (QoL) and functional mobility of RA patients after medication. Methods Eighty-four RA patients were selected as study participants, including 42 patients receiving medication (medication group) and 42 patients receiving NWM plus multirehabilitation training (NWM + MRT group). The scores of disease symptoms, pain (visual analogue scale (VAS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), functional mobility (Fugl–Meyer assessment scale (FMAS)), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and QoL (SF-36) were compared before and after treatment. When patients were discharged from the hospital, they were given a questionnaire for treatment satisfaction. Results After treatment, decreases in the scores of the VAS, PSQI, SAS, and SDS were observed in both cohorts, especially in the NWM + MRT group (P < 0.05). The FMAS scores of upper limbs and lower limbs were increased after treatment, which were higher in the NWM + MRT group in comparison with the medication group (P < 0.05). Of note, patients in the NWM + MRT group scored higher in various dimensions of the SF-36 scale (P < 0.05), showing better QoL. The satisfaction survey showed that the NWM + MRT group had a higher proportion of patients being satisfied and a lower proportion of patients being dissatisfied (P < 0.05). Conclusion NWM plus multirehabilitation training could significantly attenuate disease symptoms, improve QoL, recover functional mobility, and reduce the risk of anxiety and depression in RA patients.

Quality of Life and Depression in Rheumatoid Arthritis Patients Treated with Biologics - A Single Centre Experience.

IntroductionPatients with rheumatoid arthritis (RA) often experience depression, which has a very negative impact on the assessment of the quality of life (QoL). However, there are not many studies that assess the relationship between depression and QoL in RA patients. The aim of the study was to assess the level of QoL and determine the mutual relationship between anxiety and depression levels and QoL in patients treated for RA.Material and MethodsThe study included 101 patients (aged:52.4±16.97), who met the established criteria for a diagnosis of RA and treatment with a biological agent. Only standardized tools were used to examine the patients: WHO-QoL, HADS and the VAS scale.ResultsThe mean RA duration in the group studied was 13.54±9.51 years and the disease activity score was 4.8±0.8. The mean QoL perception score was 3.48± 0.8. Nearly 40% of the respondents could not clearly determine their QoL, perceiving it as neither poor nor good, and 10% believed their QoL is poor or very poor. The correlation analysis revealed that anxiety is significantly and negatively associated with QoL in the psychological domain (r = −0.472, p < 0.001) and social domain (r = −0.298, p = 0.023) and depression is significantly and negatively associated with QoL in the psychological domain (r = −0.322, p = 0.01) and physical health domain (r = −0.209, p = 0.04). In the multiple linear regression model, depression was an independent negative predictor affecting the following domains: perception of QoL and perception of health, and physical health.ConclusionRA patients treated with biologics present a low level of health perception and an average level of QoL perception. Depression and anxiety negatively correlate with QoL domains: the higher the anxiety and depression levels, the poorer the QoL in the psychological and social relationships domains. Depression is an independent determinant of decreased QoL.

Factors associated with anxiety and depression in rheumatoid arthritis patients: a cross-sectional study

BackgroundThe management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication.MethodsWe conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses.ResultsOf 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48–1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81–2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02–1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09–1.35]; p < 0.01). Additionally, HAQ-DI scores > 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85–6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56–4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03–2.67]; p = 0.04).ConclusionsNo association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI-based non-remission were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient’s overall sense of well-being.

A statistical analysis on the remission of pain and the intensity of depression in rheumatoid arthritis patients

Rheumatoid arthritis and depression commonly occur together. Although this is known, people with rheumatoid arthritis often aren't screened for depression, so it may not be diagnosed or treated. The main aim of the work is to evaluate the remission of pain and estimate intensity of depression in rheumatoid arthritis patients. We collected 40 cases of Rheumatoid arthritis at VIRRD hospital and collected the details. By using Visual analogue scale we have estimated the pain remission and by using Beck Depression Inventory we evaluated intensity of depression. This study shows the Adults (Above 18 years) are affected more with RA than that of other age groups. This study reveals that people affected with RA are 80% of female. So that females are more affected. As chronic pain is the important symptom of RA we evaluated the remission of pain. We observed there is decrease in pain after using the medication which indicates that there is remission of pain in patients when they are on regular treatment. This study showed a strong relation between RA and subsequent risk of depression. Based on the study almost 62.5% RA patients have some level of depression. We suggest that for optimal care and better outcomes of RA patient, detection and management of depression is important as there is some level of depression in RA patient and for such patients the treatment should be based on their level.

SAT0107 BIOLOGIC THERAPY WITH RITUXIMAB DECREASES PREVALENCE OF ANXIETY AND DEPRESSION IN RHEUMATOID ARTHRITIS PATIENTS

Background:Evidence suggests rheumatoid arthritis (RA) confers an increased risk of psychological morbidity, particularly anxiety and depression, which may affect the subsequent management and treatment adherence.1,2Few studies have studied psychological factors over time in RA patients.3Objectives:To evaluate the prevalence of anxiety and depression in RA patients following rituximab treatment.Methods:92 biologics-naïve RA patients [mean (SD) age 49.5 (9.9) years, 78 women; median (IQR) DAS28 5.67 (3.94–8.45); median (IQR) HAQ 1.87 (1.2–3.5)] were followed up for 27 months after commencing and continuing rituximab therapy (1, 2, 3 standard courses). Anxiety and depression, and health-related quality of life (HRQoL) were assessed at baseline, 3, 15 and 27 months using the Hospital Anxiety and Depression Scale (HADS) and the Short Form (SF-36 v.1) Health Survey questionnaire, respectively.Results:Median anxiety and depression scores decreased significantly between baseline and 3 months and continued depress over the 27-month period – Table. The prevalence of depression cases decreased twice from baseline to 27 months (p&lt;0.01), as did the prevalence of anxiety (p&lt;0.01). Patients reported poor baseline HRQoL. SF-36 domain scores substantially rose after 15 and 27 months.Anxiety, depression, and quality of lifeBaseline3 months15 months27 months(n=92)(n=92)(n=53)(n=14)Anxiety cases (HADS-A score ≥8), n (%)72 (78.3)48 (52.2)24 (45.3)*5 (35.7)**Median (IQR) Anxiety score12.6 (10–15)8.2 (5–12)*6.4 (3–10)**5.5 (3–8)***Depression cases (HADS-D score ≥8), n (%)62 (67.4)50 (54.3)19 (35.8)*4 (28.6)**Median (IQR) Depression score9.2 (7.8–9.6)5.6 (3–8)**4.5 (2–7)**3.6 (2–6)***Mean (SD) Mental Health score42.8 (15.2)51.2 (18.3)68.7 (11.2)*72.9 (10.5)**Mean (SD) Physical Function score24.4 (8.3)32.5 (9.8)53.8 (10.5)*54.5 (9.3)*Mean (SD) Social Function score48.2 (15.4)56.8 (25.5)59.8 (18.7)65.9 (9.2)*Mean (SD) General Health score35.8 (11.2)48.7 (10.8)67.8 (8.6)**75.9 (12.6)*** p&lt;0.05, ** p&lt;0.01, *** p&lt;0.001 differences between baseline and follow-upConclusion:Anxiety and depression levels decrease significantly in RA patients following commencement and continuity of rituximab. B cell-directed therapy for patients with RA helps achieve remission of both anxiety and depression, and improves HRQoL.

Depression in rheumatoid arthritis patients: Screening for a frequent yet underestimated comorbidity

Aim of the workTo screen for depression and assess its frequency in rheumatoid arthritis (RA) patients and to study its relation to clinical parameters, patient-reported outcomes (PROs) and disease activity. Patients and methodsThis study included 200 consecutive adult RA patients. Clinical and laboratory investigations were performed. PROs including tender and swollen joint count, patient’s estimated pain, patient global assessment (PGA), validated Arabic version of the health assessment questionnaire (HAQ-A) as well as physician global assessment were considered. The disease activity score (DAS28) and simplified erosion narrowing score (SENS) were calculated. Patient health questionnaire-9 (PHQ-9) was used to detect depression. ResultsThe patients’ mean age was 41.3 ± 11.9 years and disease duration 6.6 ± 4.9 years, 79% were females and 21% males (F:M 3.8:1). Their mean DAS28 was 6 ± 1.7 and HAQ-A 1.9 ± 0.9. The mean PHQ-9 score was 7.6 ± 9.3. 45% of patients had depression; mild (3%), moderate (13%), moderate/severe (13%) and severe (16%) degrees. PHQ-9 significantly correlated with age, disease duration, morning stiffness, joint deformity, C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor and negatively with disease modifying anti-rheumatic drugs usage (p = 0.002). All PROs and DAS28 significantly correlated with PHQ-9 (p < 0.0001). Logistic regression analysis showed that joint surgery (p = 0.004), steroid usage (p = 0.005), functional status (p < 0.0001) and joint damage (p < 0.0001) independently significantly increased the probability of depression occurrence. ConclusionDepression is common among rheumatoid arthritis patients. Periodic routine screening for depression in RA should be included in clinical practice to prevent poor outcomes and to adapt therapies to the specific situation of individual patients.

The prevalence of depression in rheumatoid arthritis in China: A systematic review.

This systematic review is to explore the prevalence of depression in patients with rheumatoid arthritis (RA) in China. Articles of prevalence rates for depression in adult RA patients published before October 2015 were identified from PubMed, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang database and other internet databases. Relevant journals and the recommendations of expert panels were also searched manually. Two independent reviewers searched and assessed the literature. Therelevant data were applied with Meta-Analyst 3.13 software, and the forest plot and funnel plot were performed. 21 studies with a total of 4447 patients were selected to be enrolled in this study. The prevalence of depression by analyzing the effect size was 48% [95% CI (41%, 56%)]. The prevalence of minor depression and dysthymic disorder was 30% [95%CI (23%, 38%)], and the moderate or major depression was 18% [95%CI (11%, 29%)], respectively. Subgroup analysis showed that the depression rate of female RA patients was higher than male. The depression rate in the central and western areas were higher than that of the eastern region of China, the prevalence level estimated by the Geriatric Depression Scale (GDS) was higher than estimated by other tools. Sensitivity analysis showed that the pooled effect size had good stability and reliability, To be conclusive, the prevalence rate of depression in RA patients is 48%, which suggesting that medical staff should pay more attention to depression in adult patients with RA.

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients

IntroductionFatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). GoalsIn this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. MethodMulticenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April–August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. ResultsThere were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. ConclusionSocioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

Validation of Standardized Questionnaires Evaluating Symptoms of Depression in Rheumatoid Arthritis Patients: Approaches to Screening for a Frequent Yet Underrated Challenge.

To validate standard self-report questionnaires for depression screening in patients with rheumatoid arthritis (RA) and compare these measures to one another and to the Montgomery-Åsberg Depression Rating Scale (MADRS), a standardized structured interview. In 9 clinical centers across Germany, depressive symptomatology was assessed in 262 adult RA patients at baseline (T0) and at 12 ± 2 weeks followup (T1) using the World Health Organization 5-Item Well-Being Index (WHO-5), the Patient Health Questionnaire (PHQ-9), and the Beck Depression Inventory II (BDI-II). The construct validity of these depression questionnaires (using convergent and discriminant validity) was evaluated using Spearman's correlations at both time points. The test-retest reliability of the questionnaires was evaluated in RA patients who had not undergone a psychotherapeutic intervention or received antidepressants between T0 and T1. The sensitivity and the specificity of the questionnaires were calculated using the results of the MADRS, a structured interview, as the gold standard. According to Spearman's correlation coefficients, all questionnaires met convergent validity criteria (ρ > |0.50|), with the BDI-II performing best, while correlations with age and disease activity for all questionnaires met the criteria for discriminant validity (ρ < |0.50|). The only questionnaire to meet the predefined retest reliability criterion (ρ ≥ 0.70) was the BDI-II (rs = 0.77), which also achieved the best results for both sensitivity and specificity (>80%) when using the MADRS as the gold standard. The BDI-II best met the predefined criteria, and the PHQ-9 met most of the validity criteria, with lower sensitivity and specificity.

Is major depression associated with serum levels of tumor necrosis factor-alpha in patients with rheumatoid arthritis?

ObjectiveThis study presents the serum tumor necrosis factor-alpha (TNF-α) levels in rheumatoid arthritis (RA) patients with major depression and without any psychiatric disorder. MethodsThe study sample included 61 patients with a diagnosis of RA. Major depression and other psychiatric disorders were screened with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Blood sample for the determination of serum TNF-α level was obtained before the psychiatric interview. ResultsThe prevalence rates of any depressive disorder and any anxiety disorder were 40.3% (n=25) and 22.6% (n=14), respectively. Fifteen (24.2%) patients had major depression alone, whereas 27 (43.5%) patients were not diagnosed with any psychiatric disorder. We could not determine any significant differences between the patients with major depression alone and patients without any psychiatric diagnosis with regard to the serum levels of TNF-α. ConclusionsThe existence of major depression in RA patients does not seem to be associated with serum levels of TNF-α.