Distress In Rheumatoid Arthritis Research Articles

A meta-analysis of coping strategies and psychological distress in rheumatoid arthritis.

Theory and research indicate that coping plays a central role in the experience of psychological distress in people with rheumatoid arthritis (RA). This study meta-analysed the associations of adaptive and maladaptive coping strategies with psychological distress in people with RA to quantify and better understand the proposed differential relationships, as well as the factors that might influence these links. Searches of four databases identified eligible studies according to a pre-registered protocol. Two random effects meta-analyses examined the direction and magnitude of the links between adaptive coping (problem-focused and emotional approach coping) and maladaptive coping (emotional avoidance and pre-occupation coping) and psychological distress (stress, anxiety, and depression). Study quality was evaluated using a bespoke tool. Moderator analyses for sample characteristics and distress type were conducted. Searches identified 16 eligible studies with 46 effects. Meta-analysis of maladaptive coping and distress yielded a significant, medium sized association, k = 12, r = .347, 95% CIs [.23, .46]. Moderator analyses were significant only for type of distress, with effects for depression being larger than that for combined distress. Effects did not vary as a function of age, participant sex, or disease duration. Meta-analysis for adaptive coping was not significant, k = 10, r = -.155, 95% CIs [-.31, .01]. Findings from this first meta-analysis of coping and distress in RA indicate that maladaptive but not adaptive coping is associated with greater distress. Further research is needed to grow the evidence base to verify the current findings especially with respect to adaptive coping.

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.

RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures.

To analyze a RheuMetric checklist, which includes four feasible physician 0 to 10 scores for DOCGL, inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) for criterion and discriminant validity against standard reference measures. A prospective, cross-sectional assessment was performed at one routine care visit at Liverpool Hospital, Sydney, Australia. Rheumatologists recorded DOCGL, DOCINF, DOCDAM, DOCSTR, and 28 joint counts for swelling (SJC), tenderness (TJC), and limited motion/deformity (DJC). Patients completed a multidimensional health assessment questionnaire (MDHAQ), which includes routine assessment of patient index data (RAPID3), fibromyalgia assessment screening tool (FAST4), and MDHAQ depression screen (MDS2). Laboratory tests and radiographic scores were recorded. RheuMetric estimates of inflammation, damage, and distress were compared with reference and other measures using correlations and linear regressions. In 173 patients with RA, variation in RheuMetric DOCINF was explained significantly by SJC and inversely by disease duration; variation in DOCDAM was explained significantly by DJC, radiographic scores, and physical function; and variation in DOCSTR was explained significantly by fibromyalgia and depression. RheuMetric DOCINF, DOCDAM, and DOCSTR estimates were correlated significantly and specifically with reference measures of inflammation, damage, and distress, documenting criterion and discriminant validity.

Obesity, Adipokines, and Chronic and Persistent Pain in Rheumatoid Arthritis

We aimed to determine whether adipokines are associated with pain and polysymptomatic distress in patients with rheumatoid arthritis (RA) over time in a large patient registry. The cohort study was conducted in a subset of Forward; a patient-based multi-disease, multipurpose rheumatic disease registry with patients enrolled from community-based rheumatology practices across the U.S. Adipokines (adiponectin, leptin, and fibroblast growth factor[FGF]-21) were measured on stored serum as part of a multi-analyte panel. Body mass index (BMI), pain, polysymptomatic distress, and other patient-reported outcomes (PROs) were reported on biannual questionnaires. Linear regression was used to evaluate independent associations between BMI, adipokines, and PROs. Cox proportional hazards models evaluated independent associations between adipokines and clinically meaningful changes in pain over time (change in numerical rating>1.1 [range 0–10], sustained over 1 year). Among 645 patients included in these analyses, there were significant differences in RA characteristics, comorbidity, PROs, and adipokines across obesity categories. Of note, severely obese patients were more likely to experience greater pain, polysymptomatic distress, and fatigue. Patients with higher FGF-21 levels had higher pain and polysymptomatic stress at baseline, were more likely to use opioids, and were more likely to have sustained worsening pain over time [HR (per 1 SD) (95% CI): 1.22 (1.02,1.46) P = .03] independent of BMI. Obesity and elevated levels of FGF-21 are associated with pain and polysymptomatic distress in RA. Elevated FGF-21 levels may help identify those at risk of worsening pain trajectories over time, independent of BMI. PerspectiveThis study characterizes the relationship between severe obesity and pain and polysymptomatic distress in patients with rheumatoid arthritis and demonstrates that the adipocytokine fibroblast growth factor-21 is independently associated with pain and predicts a worsening trajectory over time. Further mechanistic studies are needed.

056 Development of the rheumatoid arthritis distress scale: a new tool to identify disease-specific distress in patients with rheumatoid arthritis

056 Development of the rheumatoid arthritis distress scale: a new tool to identify disease-specific distress in patients with rheumatoid arthritis

277 Online interventions for addressing psychological distress in people with rheumatoid arthritis and other long-term conditions: a systematic review

Psychological distress in rheumatoid arthritis (RA) is significantly higher than the general population and impacts disease activity and treatment outcomes. Online interventions have the potential to reach large numbers of patients. This study aimed to identify online interventions for psychological distress and determine their effectiveness in people with RA and other long-term conditions. https://academic.oup.com/rheumatology/article/57/suppl_3/key075.501/4971403?searchresult=1

Illness perceptions account for variation in positive outlook as well as psychological distress in Rheumatoid Arthritis

Psychological distress in Rheumatoid Arthritis (RA) is associated with adverse clinical outcomes, and appears highly related to patients' illness perceptions. This study aimed to investigate the association between illness perceptions, psychological distress, positive outlook and physical outcomes in RA. Two hundred and thirty patients aged >18 years and prescribed at least one disease-modifying anti-rheumatic drug (DMARD) were recruited from outpatient clinics across Hertfordshire (England). Patients completed a questionnaire that assessed psychological distress and positive outlook (Depression, Anxiety and Positive Outlook Scale), illness perceptions (IPQ-R) and functional disability (Health Assessment Questionnaire). Information regarding prescribed medication and disease activity [Disease Activity Score (DAS28)] was collected from medical notes. Psychological distress, but not positive outlook, was associated with functional disability and DAS28. After controlling for sex, age and DAS28, perceptions of greater symptomatology (identity) and lesser understanding of RA (coherence) were significantly associated with increased psychological distress. Perceptions of greater treatment control were associated with greater positive outlook, but only for those with low DAS28. Coherence was also associated with positive outlook. These findings indicate that illness perceptions may influence psychological distress and positive outlook in RA patients, and may therefore be a useful basis for future psychological interventions.

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Introduction: The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test–retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion: The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables.Implications for RehabilitationPsychological distress is a relevant problem in rheumatoid arthritis patients and should be recognized early in the disease as it might reflect a lack of social resources which can be crucial in the further course of the disease.Special attention should be paid to different types of social support in relation to psychological distress, which might improve targeting psychosocial interventions.

The prospective association between psychological distress and disease activity in rheumatoid arthritis: a multilevel regression analysis

BackgroundCross-sectional associations suggest a mutual impact of disease activity and psychological distress in rheumatoid arthritis (RA), but a prospective association has not been established.ObjectiveTo examine concurrent and prospective associations between...

Longitudinal association between coping and psychological distress in rheumatoid arthritis: a systematic review

ObjectiveTo examine the longitudinal association between coping and psychological distress in rheumatoid arthritis (RA).MethodsBibliographic databases up to July 2010 were searched for longitudinal studies with a follow-up of ≥6 months....

Psychological well‐being in rheumatoid arthritis: a review of the literature

The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition.

Disability, social support, and distress in rheumatoid arthritis: Results from a thirteen‐year prospective study

To examine the strength and stability of the relationships between disease-related factors (joint tenderness, pain, and functional disability), social support, and distress over time, and to investigate to what extent disease-related factors and social support can predict distress in short-term and long-term rheumatoid arthritis (RA). The study was a Dutch extension of the European Research on Incapacitating Diseases and Social Support and started with 292 patients. After 5 waves of data collection, 129 patients remained. Composite measures were computed following the area under the curve approach. Interaction terms were computed between functional disability and social support satisfaction. Correlational and hierarchical regression analyses were performed. In patients with short-term RA, disease-related factors and social support were important in determining distress. Also, a buffering effect of social companionship was found. In total, 51% of the variance in distress in short-term RA could be explained primarily by mean distress over the previous years. In patients with long-term RA, disease-related factors remained important in determining distress, but to a lesser extent. Seventeen percent of the variance in distress in long-term RA could be explained primarily by mean distress over the years before. During the course of the disease, patients may learn to adjust to their disease and its consequences and are able to maintain a normal distress level. The effect of the disease on psychological distress decreased over the years. Some support for the buffering hypothesis of social support was found in short-term RA, but not in long-term RA.

The impact of early rheumatoid arthritis on psychological distress. A comparison between 238 patients with RA and 116 matched controls.

The objective of our study was to estimate the impact of early rheumatoid arthritis (RA) on psychological distress by comparing patients with RA and matched controls. A sample of 238 patients (age 20-70 years, mean age 52 yrs) with RA of 0 to 4 years duration (mean 2.2 yrs), was compared to 116 control persons matched to the patients with respect to sex, age, and geographic area. Data were collected through self-report questionnaires. Patients with RA rated their mental health significantly lower than the controls. Symptoms of anxiety and depression were significantly higher among arthritic patients. Twenty% of the patients had scores indicating possible psychiatric caseness compared to 6% of the controls. However, controlling for pain, disability, and fatigue, there was no significant difference in psychological distress between the patients and the controls. RA appears to have a strong impact on mental distress even early in the disease. The present study demonstrates that pain, disability, and fatigue are strongly related to the increased levels of psychological distress in RA.

Characterizing the meaning of psychological distress in rheumatoid arthritis.

Symptoms of depression are frequently reported by people with rheumatoid arthritis (RA). To advance our understanding of how best to assess and treat these symptoms, their meaning must be elucidated. This article explores two possible meanings for the emotional distress of RA patients reported on the Center for Epidemiological Studies Depression (CES-D) scale: (1) Certain CES-D scale items may inflate actual depressive symptom scores. (2) Depressive symptoms are experienced and/or expressed in unique ways in an RA population due to the presence of chronic physical symptoms. In this study of 988 people with RA, it was found that there is some modest inflation of the CES-D scale due to the items of "having difficulty getting going" and "everything was an effort." However, irrespective of the modest inflation of the scale, there is evidence that distress in RA is not a static concept. Distress in this RA population was expressed differently from that of a community population, and within the RA population, distress was expressed differently over time.