Psychological interventions for patients with rheumatic diseases and anxiety or depression

Sociodemographic and health system factors associated with variations in hospitalization costs for rheumatic diseases in adults aged 45 years and older: A cross-sectional study of provincial health accounts in Jiangsu Province, China

AIM

To report the cost of hospitalization and the associated risk factors for rheumatic diseases in middle-aged and elderly patients in China.

METHODS

The study participants included inpatients from hospitals of various levels in the Jiangsu Province Health Account database in 2016. Participants were selected by using a multistage sampling method. Patients <45 years of age were excluded, and patients hospitalized for rheumatic diseases were identified according to the 10th edition of the International Classification of Diseases. Generalized linear models were used to analyze the sociodemographic characteristics related to the hospitalization costs of patients with rheumatic diseases.

RESULTS

The study included 3696 patients. The average cost of hospitalization for patients with rheumatic diseases was USD 4038.63. Female sex, a long length of stay, age between 65 and 74 years, free medical care, not being covered by the Urban-Rural Residents Basic Medical Insurance, and a high hospital level were associated with high hospitalization costs.

CONCLUSION

This study examined hospitalization costs and relevant influencing factors in middle-aged and elderly patients with rheumatic disease in China. Our findings are useful for further research on costs of disease and the economic evaluation of strategies to prevent rheumatic disease.

Association of self-reported arthritis with depression, anxiety, and comorbid depression/anxiety among the older Chinese adults: A cross-sectional study

BACKGROUND

Arthritis is relatively common among middle-aged and older people and is a significant public health problem. However, research on the relationship between arthritis and mental health in older populations is currently limited.

METHODS

Data were obtained from the Chinese Longitudinal Healthy Longevity Survey. The 10-item Center for Epidemiologic Studies Depression Scale and 7-item Generalized Anxiety Disorder Scale were used to evaluate depressive and anxiety symptoms. Arthritis status was self-reported. Linear and logistic regression analyses were conducted to assess the impact of arthritis on depression, anxiety, and comorbid depression/anxiety symptoms.

RESULTS

A total of 11,104 participants aged ≥65 years (mean age, 83.1 ± 11.1 years) were included in the analysis. We detected positive associations of arthritis with depression symptoms (adjusted odds ratio [OR]: 1.57, 95 % confidence interval [CI] 1.33 to 1.86), anxiety symptoms (adjusted OR: 1.48, 95 % CI: 1.15 to 1.90), and comorbid depression/anxiety symptoms (adjusted OR: 1.88, 95 % CI: 1.41 to 2.5) in the older adult population. Participants with arthritis had higher anxiety (adjusted linear regression coefficient: 0.43, 95 % CI: 0.24 to 0.63) and depression (adjusted linear regression coefficient: 0.87, 95 % CI: 0.57 to 1.14) scores compared with those without arthritis. In addition, there were no significant interaction effects between arthritis and participant characteristics on depression symptoms, anxiety symptoms, or comorbid depression/anxiety symptoms.

CONCLUSIONS

Arthritis was positively associated with depression symptoms, anxiety symptoms, and comorbid depression/anxiety symptoms among older adults. Further cohort studies are needed to validate these associations.

A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders

BACKGROUND AND OBJECTIVES

Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting.

MATERIALS AND METHODS

A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month.

RESULTS

Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72).

CONCLUSIONS

The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.

The Impact and Correlation of Anxiety and Depression on Pressure Pain Threshold of Acupoints in Patients with Chronic Pelvic Inflammatory Disease

Background

Chronic pelvic inflammatory disease (CPID) is a clinically common gynecological disease. Patients experience chronic pelvic pain and often accompany with emotional dysfunction. However, the impact and correlation of anxiety and depression on pain sensitization is not completely known.

Objective

To explore the differences and correlations among anxiety, depression, and pressure pain threshold (PPT) of acupoints in patients with CPID.

Methods

One hundred and forty-seven patients with CPID were recruited. The Visual Analog Scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ) were used to assess pain. Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the emotional state of patients. The PPT of acupoints was collected using an electronic Von Frey by two licensed acupuncturists.

Results

The CPID patients were divided into anxiety-depression group (group A) or nonanxiety-depression group (group B), according to the SAS and SDS scores. Finally, there were 73 patients in group A and 74 patients in group B. Group A had significantly higher SAS, SDS, VAS, and SF-MPQ scores than group B (P < 0.05). In addition, significant differences were observed in the PPTs of ST28 (R), ST29 (R), SP10 (R), SP9 (R), SP9 (L), ST36 (R), and LR3 (L) between the two groups (P < 0.05). No considerable differences in PPTs at the other acupoints were observed between the two groups. SAS scores showed a positive correlation with PPTs of ST29 (R), SP10 (R), SP9 (L), ST36 (R), and LR3 (L). No remarkable correlation was observed between the SDS scores and PPTs.

Conclusion

Anxiety and depression can affect the PPT of some acupoints in CPID patients, which may provide a reference for acupoint selection for acupuncture treatment of CPID with emotional disorders. This trial is registered with ChiCTR2100052632.

Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.

Correlation of Depression and Anxiety With Rheumatoid Arthritis

Background

Psychiatric comorbidity with a chronic disease is linked with poor patient outcomes. Therefore, the current research assessed the correlation of rheumatoid arthritis (RA) with depression and anxiety disorders. 

Methodology

A prospective observational study was undertaken at a public sector hospital between December 2020 to June 2021. All individuals who presented with rheumatoid arthritis were included in the study. A healthy cohort acted as the control group. Depression and anxiety were assessed using the Hamilton depression rating scale (HDRS) and the Hamilton anxiety rating scale (HAM-A), respectively. The patients were inquired about their gender, age, and duration of RA. Further stratification was done using the Chi-squared test. A p-value of <0.05 was decided as the cut-off for significance. All data from the patients were collected in a predefined pro forma. 

Results

A total of 169 patients with RA and 85 healthy controls were enrolled in the study. The mean depression score among patients with RA was 19.65 ± 1.44 versus 14.4 ± 1.31 in the control group (p<0.001). Moreover, the mean anxiety score in patients with RA was 19.44 ± 2.4. About 71% of patients with RA were diagnosed with psychiatric issues, while only 7.1% of individuals in the control group had either depression or anxiety (p<0.0001). Furthermore, it was found that the majority of the patients with RA had depression with a frequency of 70 (58.3%), while only six participants in the control group had depression. None of the participants had moderate or severe depression. However, 16 (69.6%) patients with RA had major anxiety issues. In 27 patients, mixed anxiety-depression disease was diagnosed. Out of these, 23 (85.2%) had the depression-dominant mixed disorder. 

Conclusion

The present study highlighted the alarming incidence of depression and anxiety among patients with RA. Furthermore, it also indicated the relationship between severity of psychiatric comorbidity with chronic rheumatoid arthritis in our population. Further large-scale studies are needed to ascertain the demographic confounders that may help predict psychiatric disorders among patients with RA. 

Networks of Care: A Social Network Perspective of Distributed Multidisciplinary Care for People With Inflammatory Arthritis

OBJECTIVE

To explore how multidisciplinary inflammatory arthritis (IA) care is accessed from the perspectives of people with IA and their health care network members.

METHODS

In this phenomenological study, we used purposive sampling to recruit patients with IA for less than 5 years and age of more than 18 years who spoke English and reported two or more health care network members. We conducted one-to-one interviews with patients and their health care network members. Data were analysed using a social network perspective.

RESULTS

We interviewed 14 patient participants and 19 health care network members comprising health care providers and informal caregivers. An overarching theme of whole person (holistic) IA care was identified, with the following two broad multifaceted subthemes: 1) connected networks and whole person care and 2) network disconnect and disrupted access to care. The first subtheme notes how access to health care providers and social support was fundamental to holistic care and how care was facilitated by communication pathways that promoted care. The second subtheme illustrates impediments to access, including appointment time pressures, inadequacies in communication delivery modes, and family physicians' unfamiliarity with rheumatology care. Inequities in care were also reported.

CONCLUSION

Participants shared a goal of whole person care. Although health care networks included multiple disciplines, they did not always provide coordinated multidisciplinary care. Communication modes, linkages between network actors, and organizational structures governed the flow of information and resources through networks and influenced access to equitable whole person care. The development of health care system structures to support the flow of information and resource transfer is needed to promote network collaboration and equitable access to resources.

(Un)disclosed. Disease disclosure in people living with rheumatic diseases: An exploratory study

OBJECTIVE

Little is known about disease-related disclosure (DD) in patients with rheumatic musculoskeletal diseases (RMDs). We aim to investigate DD behaviors and to explore which socio-demographic, clinical and psychological factors play a role in this self-disclosure process among patients with RMDs.

METHODS

A cross-sectional Italian nationwide study captured DD in RMDs in different contexts (workplace, family, friends, partner, social networks). An ad hoc survey was developed and disseminated by the Patients' Association ALOMAR ODV (Lombard Association for Rheumatic Diseases) between June and July 2020. Patient demographics, clinical data, and questionnaires assessing anxiety, depression, anticipated stigma, patient health engagement, perceived social support, and perceived general health status were collected.

RESULTS

There were 376 rheumatic patients who completed the survey. There were 73.9% of the participants who talk to others about their RMD "sometimes"; 18.7% disclose their RMD "always/very often", while 7.4% "never" talk about their RMD. A significant association was detected between DD and both perceived visibility (P = .04) and psychological support (P = .01). Moreover, participants who never/sometimes disclose their RMD reported significantly lower scores in the "Total" Social Support (P < .01) and in the "Friends" subscale (P < .001) compared to others. Psychological support and the "Friends" subscale were the only significant predictors of DD (both P = .002).

CONCLUSIONS

The majority of RMD patients disclosed their disease "sometimes". The DD behavior is not associated with any specific demographic or clinical variables. Further research on the subject might help to foster better DD decision-making processes for rheumatic patients in different contexts of daily life.

Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi‑center study

This article aims to evaluate the possible effect of obesity on quality of life, psychological status, and other clinical variables in Psoriatic arthritis (PsA). PsA patients have been recruited by the Turkish League Against Rheumatism-Network from various centers in Turkey in this cross-sectional study. Patients with a body mass index (BMI) ≥ of 30 kg/m² were considered obese. Differences among patients with regard to obesity status were assessed with health-related quality of life measures (PsA Quality of Life Questionnaire [PsAQoL]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and disease activity parameters (the Disease Activity index for PSoriatic Arthritis [DAPSA], Disease Activity Score 28-C-reactive protein [DAS28-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Psoriasis Area and Severity Index [PASI]), physical functions (Ankylosing Spondylitis Functional Index [BASFI], Health Assessment Questionnaire [HAQ], and Health Assessment Questionnaire for the spondyloarthropathies [HAQ-S]). Pain was assessed using visual analog scale of pain (VAS-P), and fatigue was evaluated using visual analog scale of fatigue (VAS-F) and Functional Assessment of Chronic Illness Therapy (FACIT). A total of 1033 patients with PsA, 650 (62.9%) non-obese and 383 (37.1%) obese were included in the study. The PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ and HAQ-S scores of the obese group were higher than the non-obese group (p < 0.05). VAS-P and PASI scores were similar between group of patients with and without obesity. Obese patients had higher median scores of VAS-F and FACIT than non-obese patients (p < 0.05). Linear regression analysis showed that BMI affects the quality of life, depression, and disease activity. Consequently, obesity has significant associations with higher disease activity, lower QoL, risk of anxiety, depression, and fatigue. Therefore, obesity should also be taken into account in the management of PsA patients.

The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease

OBJECTIVES

To determine the psychological impact of the COVID-19 pandemic on people with and without an inflammatory rheumatic disease and establish whether psychological flexibility buffers this impact.

METHODS

From online surveys in the general Dutch population in 2018 and during the peak of the COVID-19 pandemic in 2020, we analysed data of people with (index group, n = 239) and without (control group, n = 1821) an inflammatory rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological flexibility levels were subjected to covariate-adjusted analyses of variance or linear regression analyses.

RESULTS

During the peak of the COVID-19 pandemic in 2020, as compared with the control group, the index group was more worried about getting infected with the virus (partial η2=0.098; medium effect) and more stressed (partial η2=0.040; small effect). However, as compared with data acquired in 2018, the level of mental well-being during the COVID-19 pandemic peak was not lower in both groups. Levels of psychological flexibility did not moderate associations of group or year with mental well-being.

CONCLUSIONS

Although patients with an inflammatory rheumatic disease were more worried and stressed during the peak of the COVID-19 pandemic, their level of mental well-being was not reduced, which may have prevented us from finding a buffering effect of psychological flexibility. Overall, our results suggest that the psychological impact of the COVID-19 pandemic in patients with inflammatory rheumatic disease is modest, which could imply that common education and health care will do for most patients.

Mental Comorbidity in Rheumatic Diseases

In this review, we summarise the most relevant studies in a PubMed Search term “mental disorders and rheumatic disease” in the last 15 years. Mental disorders such as depression and anxiety are common in people with rheumatic diseases. Treating these comorbidities can improve the patientʼs quality of life. The high prevalence of symptoms of psychiatric disorders is a challenge for rheumatologists, especially with regard to the differentiation of possible psychiatric components in rheumatological diseases. Screening for psychiatric problems in patients with rheumatic diseases should be evaluated as soon as possible, as these can have a major influence on the perception of pain and physical functioning status from the outset. Mental health disorders are seen as a risk factor for poor patient outcomes, as patients may not adhere to medical treatments. The potential side effects of biological agents can increase patient anxiety and affect adherence to therapy. Therefore, interdisciplinary care would be of great advantage in the treatment of rheumatic patients with psychological comorbidities.

Prevalence of Anxiety, Depression, Sleep Disturbance, Fibromyalgia, Obesity, and Gastroesophageal Disease in Patients with Rheumatic Diseases

BACKGROUND

Patients with rheumatologic disorders often have comorbidities that complicate their psychological well-being. In this study, we looked at 216 patients with rheumatoid arthritis (RA), systemic lupus erythematous (SLE), psoriatic arthritis (PsA), and Sjogren's syndrome (SS) to determine the prevalence of anxiety, depression, sleep disturbance, fibromyalgia (FM), obesity (BMI greater than 23), and gastroesophageal disease (GERD) and the correlation between FM, BMI, disease activity measure, known as Routine Assessment of Patient Index Data 3 (RAPID3).

METHODS

Study participants were 216 rheumatology patients seen at the UCF Pegasus Health Clinic from November 2011 to May 2014 with one or more of the following diseases: RA, SS, SLE, or PsA. 116 had rheumatoid arthritis, 27 with systemic lupus erythematous, 22 with psoriatic arthritis, 20 with Sjogren's syndrome, and 31 with more than one diagnosis. Variables that were collected from patients' charts included RAPID3 scores, patient demographics (age, sex), BMI, presence of GERD, and presence of FM. Each patient was randomly assigned, unique and had an unidentifiable study number.

RESULTS

Anxiety, depression, sleep disturbance and obesity were found to be more prevalent in patients with Sjogren's syndrome, and fibromyalgia was noted to be more prevalent in patients with more than 1 diagnosis. The presence of fibromyalgia was significantly correlated with higher RAPID3 scores in all patients except those with PsA. Significant correlation among higher BMI and greater RAPID3 scores was found for patients with rheumatoid arthritis and for patients with Sjogren's syndrome.

CONCLUSION

Our study showed an increased prevalence of anxiety in patients with Sjogren's syndrome. Fibromyalgia was found to be related to higher disease activity scores. In RA and SS patients, BMI was significantly correlated with higher RAPID3 scores. These results provide a basis for future studies to evaluate these correlations in more detail.

Anxiety and depression in reproductive age women with rheumatic diseases

Women in reproductive age with rheumatic diseases (RD) are especially vulnerable for depression and anxiety which negatively impacts the pregnancy, birth, and RD. The purpose of this study is to describe the frequency of anxiety and depression symptoms employing the Hospital Anxiety and Depression Scale (HADS) in women in reproductive age. We conducted an observational, single-center, cross-sectional, and descriptive study in reproductive-age, non-pregnant women without a prior psychiatric diagnosis. Differences between disease groups, subscale results, and disease activity were analyzed with the Chi square, Mann-Whitney U test, or Kruskal-Wallis test. A total of 100 women were included. Mean age was 35.3 years (SD = 10.07). The most frequent diagnosis was rheumatoid arthritis (RA) with 48, followed by systemic lupus erythematosus (SLE) with 30. A total of 66 (66%) patients had an abnormal HADS score (probable or possible cases) in either subscale. More than 50% of RA patients had an abnormal HADS score. We found an association between RA disease activity groups and total HADS score (p = 0.003). Furthermore, we found a statically significant association between RA activity groups and HADS anxiety subscales group classification (p = 0.01). No differences between disease activity groups of SLE or other diseases and HADS classification or total score was found (p = 0.277). A high frequency of probable or possible cases of depression and anxiety were recognized in reproductive-age women with RD. A high RA disease activity was associated with a high total HADS score and an increased presence of anxiety symptoms.

Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms

Today, inflammatory rheumatic disorders are effectively treated, but many patients still suffer from residual fatigue. This work presents pathophysiological mechanisms of fatigue. First, cytokines can interfere with neurotransmitter release at the preterminal ending. Second, a long-term increase in serum concentrations of proinflammatory cytokines increase the uptake and breakdown of monoamines (serotonin, noradrenaline and dopamine). Third, chronic inflammation can also decrease monoaminergic neurotransmission via oxidative stress (oxidation of tetrahydrobiopterin [BH4]). Fourth, proinflammatory cytokines increase the level of enzyme indoleamine-2, 3-dioxygenase activity and shunt tryptophan away from the serotonin pathway. Fifth, oxidative stress stimulates astrocytes to inhibit excitatory amino acid transporters. Sixth, astrocytes produce kynurenic acid that acts as an antagonist on the α7-nicotinic acetylcholine receptor to inhibit dopamine release. Jointly, these actions result in increased glutamatergic and decreased monoaminergic neurotransmission. The above-described pathophysiological mechanisms negatively affect brain functioning in areas that are involved in fatigue.

A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.

Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis

This study aimed to assess the effects of cognitive behavioral therapy on the psychological and physiological health of rheumatoid arthritis patients. An extensive literature search was conducted, using the PubMed, Web of Science, Cochrane Library, Embase, CNKI Scholar, WanFang, and VIP databases, from inception to December2018. The quality of the studies was evaluated by 2 independent authors, according to the basic criteria provided by the Cochrane Handbook for evaluating randomized trials. Meta-analysis was performed with Review Manager 5.3. Six randomized controlled trials met the inclusion criteria of the current study. Using standard mean differences (SMD) and 95% confidence intervals (CI), our results showed that cognitive behavioral therapy could significantly reduce levels of anxiety (SMD = -0.30, 95% CI [-0.52, -0.09], P= 0.005) and depression (SMD = -0.48, 95% CI [-0.70, -0.27], P< 0.00001), and relieve fatigue symptoms (SMD = -0.35, 95% CI [-0.60, -0.10], P= 0.006) in rheumatoid arthritis patients.This is the first known assessment of the efficacy of cognitive behavioral therapy on rheumatoid arthritis patients using meta-analysis. Large-scale randomized controlled trials need to be implemented to further explore this issue.

The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis

Background

The prevalence of mood disturbances such as anxiety and depression is greater in rheumatoid arthritis (RA) patients than in the general population. Given this association, the primary aim of this study was to assess the incremental impact of anxiety or depression on patients with RA from the United States of America (USA) and Europe, independent of the impact of the underlying RA disease.

Methods

Rheumatologists (n = 408) from the USA and 5 European countries completed patient record forms for a predetermined number of RA patients who consulted consecutively during the study period; these patients completed patient-reported questionnaires. Descriptive statistics and multivariate regression were used to investigate the relationship between anxiety and depression with treatment and economic outcomes in RA patients.

Results

Of 1015 physician and patient pairs who completed all relevant questionnaire sections, 390 (38.4%) patients self-reported anxiety or depression, while 180 (17.7%) patients were reported to have anxiety or depression by their physicians. Controlling for age, gender, body mass index and clinical factors (flaring and severity), multiple regression analyses suggested that patients with anxiety or depression more often experienced treatment dissatisfaction (odds ratio [OR] 2.28; P < .001), had greater impairment in work (coefficient [β] = 11.82; P = .001) and usual activity (β = 14.73; P < .001), greater disability (β = .35; P < .001), and more often reported unemployment (OR 1.74; P = .001). Multinomial logistic regression revealed discordance between physician and patient satisfaction with treatment. For patients reporting anxiety or depression, physicians were more often satisfied with achievement of current disease control than patients (relative risk ratio 2.19; P = .002).

Conclusion

Concomitant anxiety or depression was associated with a significant incremental impact on the health-related quality of life and economic aspects of life of patients with RA. In light of observed differences between physician recognition of patient anxiety and/or depression versus patient reporting of anxiety and/or depression symptoms, further research is warranted to develop optimal screening and management of depression and anxiety in patients with RA.

Quality of life in Ecuadorian patients with established rheumatoid arthritis

Purpose

To evaluate quality of life in patients with established rheumatoid arthritis (RA) and identify the factors that negatively affect it.

Methods

This was a cross-sectional study with patients with established RA from a rheumatology center in Ecuador. The RA Quality of Life (RAQoL) questionnaire was used to assess QoL and the Health Assessment Questionnaire — disability index (HAQ-DI) questionnaire for functional capacity. In addition, demographics, clinical characteristics, and markers of disease activity were included. Data were analyzed using SPSS 22.

Results

Of 186 patients, 89.8% were women, with a mean age of 51 years, 86.6% had symmetrical polyarticular involvement, 40.3% erosions, 46.8% morning stiffness, 46.8% xerophthalmia, and 39.2% fatigue. Depression was the most frequent comorbidity — 42.5%. The mean HAQ-DI score was 0.8, and 26.9% had functional disability. The mean RAQoL score was 7.2. Xerophthalmia, xerostomia, fatigue, morning stiffness, and depression were related to higher scores in the RAQoL (p<0.05). The mean RAQoL was higher in patients with more disease activity and comorbidities (p<0.05). Likewise, patients with functional disability had a mean RAQoL score of 15.6 versus 4.1 in patients without disability (p<0.05). There were positive correlations between RAQoL and ESR, CRP, painful-joint count, swollen-joint count, VAS of pain, and physician assessment (p<0.05).

Conclusion

QoL is severely affected in patients with RA. Depression, fatigue, morning stiffness, pain, high disease activity, and disability have a negative effect on QoL in RA. Likewise, patients with more comorbidities and extraarticular manifestations show worse QoL.

Evaluation In Vivo and In Vitro of the Antioxidant, Antinociceptive, and Anti-Inflammatory Activities of Biflavonoids From Ouratea hexasperma and O. ferruginea

Ouratea species are used for the treatment of inflammation-related diseases such as rheumatism and arthritic disorders. The Ouratea genus is a rich source of flavonoids and bioflavonoids and for this reason we evaluated the effects of the biflavonoid fractions from the leaves of O. hexasperma (OHME) and O. ferruginea (OFME) in the in vivo model of complete Freund’s adjuvant (CFA)-induced arthritis and in the in vitro model of oxidative stress and cellular viability. The CFA-induced arthritis model in rats was followed by paw volume, articular incapacitation and Randall-selitto models, as well as quantification of cytokines and serum C-terminal telopeptide of type I collagen levels. OHME and OFME demonstrated antinociceptive and anti-inflammatory activities, as well as improvement in articular incapacity and reduction in levels of interleukin 1β (IL-1β), IL-6, tumor necrosis factor α, and type 1 collagen, and increased cell viability. No adverse effects were observed. The results suggest that OHME and OFME can reduce inflammation and bone resorption besides their antioxidant action.

Impact of ankylosing spondylitis on depression: a nationwide cohort study

The aim of this study is to determine the relationship between AS and subsequent depression. This study was conducted using a nationwide dataset available in Korean National Health Insurance System (KNHIS). We identified 11,465 newly diagnosed AS patients and 57,325 patients without AS in the ratio of 1:5 matched by sex, age, and index date, between 2010 and 2014. We investigated any latent characteristics in the patients’ demographic information and chronic comorbidities that could trigger a depression when diagnosed with AS. By comparing the cohort data, the hazard ratio of developing subsequent depression in AS patients was calculated and adjusted based on several risk factors. Despite the adjustment of demographic variables and chronic comorbidities, the risk of depression was 2.21 times higher in the AS cohort than in the control group. Multivariate analysis showed that AS patients with female gender, old age and low-income status showed higher risks of developing depression. Additionally, the presence of chronic comorbidities including diabetes mellitus, hypertension, hyperlipidemia, cancer, stroke, and chronic kidney disease increased the patients’ risk of depression. The AS patients with stroke were reported to have the highest risk of depression. This population-based cohort study showed that AS significantly increased the subsequent risk of developing depression. Moreover, the development of a depression is influenced by certain demographic variables and different chronic comorbidities.

The Effect of Axial Spondyloarthritis on Mental Health: Results from the Atlas

Objective.

To assess the risk of mental disorders in patients with axial spondyloarthritis (axSpA) and to examine the factors associated with this.

Methods.

In 2016, a sample of 680 patients with axSpA were interviewed as part of the development process for the Atlas of Axial Spondyloarthritis in Spain. The risk of mental disorders in these patients was assessed using the 12-item General Health Questionnaire scale. Additionally, the variables associated with the risk of mental disorders were investigated, including sociodemographic characteristics (age, sex, relationship, patient association membership, job status, and educational level), disease status (Bath Ankylosing Spondylitis Disease Activity Index, spinal stiffness, and functional limitation), and previous diagnosis of mental disorders (depression and anxiety). Bivariate correlation analyses were performed, followed by multiple hierarchical and stepwise regression analysis.

Results.

A total of 45.6% patients were at risk of mental disorders. All variables except educational level and thoracic stiffness significantly correlated with risk of mental disorders. Nevertheless, disease activity, functional limitation, and age showed the highest coefficient (r = 0.543, p ≤ 0.001; r = 0.378, p ≤ 0.001; r = −0.174, p ≤ 0.001, respectively). In the stepwise regression analysis, 4 variables (disease activity, functional limitation, patient association membership, and cervical stiffness) explained the majority of the variance for the risk of mental disorders. Disease activity displayed the highest explanatory degree (R2 = 0.875, p < 0.001).

Conclusion.

In patients with axSpA, the prevalence of risk of mental disorders is high. Combined with a certain sociodemographic profile, high disease activity is a good indicator of the risk for mental disorders.

A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis.Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes.Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group.Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed.Implications for rehabilitationPeople with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation.Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis.The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals.The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey

Objective

To investigate the existence and distribution of 2 typologies (termed “factors”) of men with rheumatoid arthritis (RA) identified through our previous Q‐methodology study (n = 30) in a larger sample of men with RA, and whether differences in psychosocial impact or support preferences exist between the 2 factors, and between men and women with RA.

Methods

A postal survey was sent to 620 men with RA from 6 rheumatology units across England, and the support preferences section of the survey was given to 232 women with RA.

Results

A total of 295 male patients (47.6%) and 103 female patients (44.4%) responded; 15 male participants had missing data, and thus 280 were included in the analysis. Of these, 61 (22%) were assigned to factor A (“accept and adapt”), 120 (35%) were assigned to factor B (“struggling to match up”), and 99 (35%) were unassigned. The two factors differed significantly, with factor B reporting more severe disease, less effective coping strategies, and poorer psychological status. For support, men favored a question and answer session with a consultant (54%) or specialist nurse (50%), a website for information (69%), a talk by researchers (54%), or a symptom management session (54%). Overall, women reported more interest in support sessions than men, with ≥50% of women reporting interest in nearly every option provided.

Conclusion

Some men accept and adapt to their RA, but others (43%) report severe disease, less effective coping, and poor psychological status. Men's preferences for support are practical, with a focus on expanding their knowledge.

Illness perception is significantly determined by depression and anxiety in systemic lupus erythematosus

Objectives Illness perception is a cognitive representation influencing physical and psychological functioning and adherence in patients with rheumatic disease. Studies exploring illness perception in systemic lupus erythematosus (SLE) are still scarce and none of them have investigated factors determining illness perception. We aimed to assess illness perception and to identify psychological, clinical and sociodemographic factors that might influence illness perception in SLE. Methods The study involved 80 patients with SLE (87.5% women, mean age 41.56 years). The Brief Illness Perception Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Visual Analogue Scale-Pain and Fatigue Severity Scale were used. Clinical and sociodemographic data were collected via structured interview and medical files review. Results Illness perception was significantly positively correlated with anxiety, depression, sleep quality, fatigue and pain while it was not related to age, education, steroid treatment, disease duration and activity (SLEDAI) or organ damage (SLICC/ACR). Regression analysis revealed that state anxiety and depression explained 43% of illness perception variance. Cluster analysis identified three patient groups among which the middle-aged group had the most negative illness perception, the highest levels of anxiety, depression, pain and fatigue, and the poorest sleep quality. Conclusions The study has proved a significant relationship between negative illness perception and anxiety and depression. Patients reporting fatigue, poor sleep and pain might have special needs in terms of psychological intervention focused on negative illness perception and distress symptoms. Multidisciplinary care in managing SLE seems to be of great importance.

Linguistic Indicators of Pain Catastrophizing in Patients With Chronic Musculoskeletal Pain

The present study examined markers of pain catastrophizing in the word use of patients with chronic pain. Patients (N = 71) completed the Pain Catastrophizing Scale and wrote about their life with pain. Quantitative word count analysis examined whether the essays contained linguistic indicators of catastrophizing. Bivariate correlations showed that catastrophizing was associated with greater use of first person singular pronouns, such as "I" (r = .27, P ≤ .05) and pronouns referencing other people (r = .28, P ≤ .05). Catastrophizing was further significantly associated with greater use of sadness (r = .35, P ≤ .01) and anger (r = .30, P ≤ .05) words. No significant relationships with positive emotion and cognitive process words were evident. Controlling for patients' engagement in the writing task, gender, age, pain intensity, and neuroticism in multiple regression, the linguistic categories together uniquely explained 13.6% of the variance in catastrophizing (P ≤ .001). First person singular pronouns (β = .24, P ≤ .05) and words relating to sadness (β = .25, P ≤ .05) were significant, and pronouns referencing other people (β = .19, P ≤ .10) were trending. The results suggest that pain catastrophizing is associated with a "linguistic fingerprint" that can be discerned from patients' natural word use.

PERSPECTIVE

Quantitative word count analysis examined whether pain catastrophizing is reflected in patients' written essays about living with pain. Catastrophizing was associated with more first person singular pronouns, more pronouns referencing other people, and more expressions of sadness and anger. The results can help understand how catastrophizing translates into communicative behaviors.

Stress and Disease Onset in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

OBJECTIVE

To explore the potential contribution of stress as a trigger for disease onset in patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV).

METHODS

53 AAV and 85 rheumatoid arthritis (RA) patients as well as 53 healthy controls (HC) were thoroughly asked for the number and impact of stressful life events, coping strategies, and available social support 12 months prior to disease onset. Anxiety, depression, personality dimensions, insomnia, and fatigue were also determined.

RESULTS

AAV patients reported higher scoring of the impact of stressful life events compared to the RA and HC group prior to disease onset (2.8 ± 3.1 vs 1.8 ± 2.1 vs 1.7 ± 2.3, p-values: 0.047 and 0.053, respectively). While the number of reported stressful events was found to be significantly higher in AAV vs RA patients but not HC, certain coping strategies and social support features were more commonly implemented by AAV patients compared to HC, but not RA patients. As far as personality and other psychosocial characteristics, AAV patients displayed significantly higher psychoticism traits compared to RA, with no other differences being detected between AAV patients and both RA and HC. After adjusting for potential cofounders, scoring of the impact of stressful life events >3 was independently associated with AAV development compared to both RA and HC [ORs (95% CI): 4.6 (1.6-13.4) and 4.4 (1.0-19.0), respectively].

CONCLUSION

The perceived impact of stressful life events prior to disease onset emerged as a contributing factor for AAV development.

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

Inflammatory rheumatic diseases have a long-lasting effect on patients' physical and psychological functioning, for instance, due to disabling symptoms and unpredictable disease course. Consequently, many patients show adjustment problems such as depressed mood, which in turn can negatively influence their disease outcome. Specific biopsychosocial factors have shown to affect this outcome. For example, daily stress, cognitive-behavioral risk factors such as pain catastrophizing and avoidance, and resilience factors such as optimism and social support influence the quality of life, physical symptoms of pain and fatigue, and inflammatory markers. Psychological interventions tackling these factors can have beneficial effects on physical and psychological functioning. Recent advances in screening for patients at risk, tailored treatment, and eHealth further broaden the efficiency and scope of these interventions while simultaneously optimizing patient empowerment. This chapter describes the biopsychosocial risk and resilience factors related to disease outcome and the possible benefits of psychological treatment strategies in inflammatory rheumatic diseases.

Patients' Perspectives on the Psychological Impact of Inflammatory Arthritis and Meeting the Associated Support Needs: Open-Ended Responses in a Multi-Centre Survey

OBJECTIVES

Psychological support for inflammatory arthritis is recommended in rheumatology treatment guidelines. Previous research found that high numbers of patients would access such support but that provision is often inconsistent and inadequate. The present study explored patients' perspectives on the nature of the psychological impact of inflammatory arthritis and how to meet the associated support needs.

METHODS

A cross-sectional survey was conducted, using questionnaires which included three open-ended questions about helpful and unhelpful psychological support. The questionnaires were administered to 1,080 patients at six regional rheumatology units across England, and 1,200 members of a national patient charity.

RESULTS

A total of 1,210 (53%) patients completed the questionnaire, with 779 (64%) responding to the open-ended questions: 80% female; mean age 59 years (12.6); disease duration <5 years (40%), 5-10 years (20%), >10 years (40%). Data were analysed using a hybrid content analysis. Four categories emerged: challenges of an altered life course (negative emotions, isolation and loneliness, a dysfunctional body, loss, strained relationships, and fears for the future); poor communication (feeling unheard, clinicians' reluctance to address psychological issues, a lack of help to manage pain and fatigue, and struggling to ask for help); understood by others (sharing with people who have arthritis, supportive family and friends, whole team support, and understanding from clinicians); and acquiring strategies (ways of coping).

CONCLUSIONS

Psychological distress was commonplace, and often attributed to fatigue and pain. In addition to peers and family, patients looked to the rheumatology team for validation and support. Further research will address the skills training needs of rheumatology teams to meet patients' psychological support requirements.

The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility

OBJECTIVES

Due to their disease, patients with polyarthritis face the task of reconciling their threatened personal goals with their capabilities. Previous cross-sectional research on patients with chronic disease related higher levels of goal management strategies to lower levels of distress and higher levels of well-being. This study was the first to focus longitudinally on goal management patterns that combined strategies originating from different goal management theories. Our first study objective was to identify patterns that consisted of various strategies of goal management among patients with polyarthritis. Subsequently, the cross-sectional and longitudinal relationships between these patterns and the psychological health of the patients were studied.

METHODS

A longitudinal questionnaire study with three measurements of goal management and psychological health was conducted among 331 patients with polyarthritis. Stability of goal management over time was analysed with ANOVAs. Patterns were identified using cluster analysis at baseline, based on the following strategies: Goal maintenance, goal adjustment, goal disengagement, and goal reengagement. Longitudinal relationships between the patterns and psychological health (specifically: Depression, anxiety, purpose in life, positive affect, and social participation) were analysed using a generalized estimating equations analysis.

RESULTS

Three goal management patterns were found: 'Moderate engagement', 'Broad goal management repertoire', and 'Holding on'. Patients with the 'Broad goal management repertoire' pattern had the highest level of psychological health. The 'Holding on' pattern was identified as the most unfavourable in terms of psychological health. Over time, stable differences in levels of psychological health between the patterns were found.

CONCLUSIONS

This study was the first to reveal patterns of several goal management strategies and their longitudinal relationship to psychological health. Psychosocial support for arthritis patients with lower psychological health should focus on helping patients to become familiar with a broad range of goal management strategies when dealing with threatened goals.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Polyarthritis is a collective term for a variety of disorders associated with autoimmune pathologies that may affect all aspects of a person's physical, psychological, and social functioning. Patients often experience difficulties in maintaining and achieving goals in several domains of life due to disease symptoms. The process of emotional adaptation to polyarthritis is characterized by searching equilibrium between desires and constraints and reacting constructive to stressors. Goal management strategies are ways to minimize the perceived disparity between the actual and the preferred situation with regard to personal goals and are applied both consciously and unconsciously. Cross-sectional, higher levels of goal management strategies have been related to lower levels of distress and higher levels of well-being both in patients with polyarthritis and in other patient groups. What does this study add? Contributes to our understanding of how combinations of goal management strategies relate to psychological health. Identifies patterns of goal management that are longitudinally related to psychological health. Provides clear guidance for improving psychological health of people with polyarthritis.

Smartphone application for rheumatoid arthritis self-management: cross-sectional study revealed the usefulness, willingness to use and patients' needs

Patient-centered smartphone applications have potential to support rheumatoid arthritis (RA) self-management but remain almost unexplored in literature. Therefore, this study evaluated the usefulness of a smartphone application to support RA self-management, the willingness of RA patients to use and pay for it and the features the application should have. In this cross-sectional study, a questionnaire was developed to collect information on population, device ownership, usefulness and willingness to use and pay for a RA self-management application and application features. Descriptive statistics, Chi-square, Fisher's exact test, t test or Mann-Whitney's test and multivariate analysis were used. One hundred RA patients answered the questionnaire. Patients' mean age was 57 ± 11.9 years, most were females (91 %), with multiple drug regimens and a 40 % treatment non-compliance rate. Most patients believed that could have a more active role in self-management (94 %) and reported it would be useful to develop a RA self-management application (86 %). Patients willing to use an application (83 %) were younger, with a possible more active role in self-management, with access to a smartphone, and using short message service, electronic mail and Internet. Multivariate analysis confirmed these results, except the associations regarding access to a smartphone and use of electronic mail and Internet. Fifty-eight patients (82 %) were willing to pay for a RA self-management application and the most requested feature for it was information in a simple format. This study suggested the usefulness and patients' willingness to use and pay for a RA self-management application and provided insight on patients' needs.

The factor structure of the hospital anxiety and depression scale in orthopedic trauma patients

Background

Many instruments exist to assess mental disorders and anxiety, such as the hospital anxiety and depression scale (HADS). Nothing has been evaluated on the HADS factor structure for use with orthopedic trauma patients. The aim of this study was to validate the underlying structure of the HADS. Specifically, we sought to understand which of the factor structures found in the literature is appropriate for the orthopedic trauma patient population.

Methods

This study included 348 patients with an average age of 49.8 years (SD: 18.4; range: 18 - 95). Confirmatory data analysis was performed to analyze the latent structure of the HADS. Akaike information criterion (AIC) was used to compare all the models, with the lowest AIC being the best fitting model.

Results

We found that both the anxiety and the depression factors were highly correlated (with Pearson correlations greater than 0.700). After removing one item from each subscale, we found that a two-factor model was the best fitting one (AIC: 8,298.901); all other models had an AIC over 10,000.

Conclusion

Our results support a satisfactory two-factor structure for the HADS in the orthopedic trauma patients. Further studies are needed to test for higher factor structures in larger samples and in a different population.

Increased risk of depression in patients with rheumatoid arthritis: a seven-year population-based cohort study

OBJECTIVE

Rheumatoid arthritis (RA) is a costly and crippling autoimmune disease that can lead to the development of depression, contributing to suboptimal clinical outcomes. However, no longitudinal studies have identified an association between rheumatoid arthritis and subsequent depression. This study aimed to investigate the incidence and risk factors of depression among RA patients in Taiwan.

METHODS

Using Taiwan's National Health Insurance Research Database, we identified 3,698 newly diagnosed RA patients aged 18 years or older, together with 7,396 subjects without RA matched by sex, age and index date, between 2000 and 2004. The incidence of depression and the risk factors among RA cases were evaluated using Cox proportional-hazard regression.

RESULTS

The incidence of depression was 1.74-fold greater in the RA cohort than in the non-RA cohort (11.80 versus 6.89 per 1,000 person-years; p<0.01). Multivariate analysis showed that RA subjects who were female, were older, or had comorbidities such as stroke, chronic kidney disease, or cancer had a significantly greater risk of depression compared with those without these conditions.

CONCLUSION

This population-based cohort study showed a strong relationship between RA and a subsequent risk of depression. The findings could be beneficial to healthcare providers for identifying individuals with a higher predisposition for depression, thereby possibly facilitating the provision of an appropriate rehabilitation intervention after RA onset to support the patient's adaptation.

Behavioral trait of morningness-eveningness in association with articular and spinal diseases in a population

Earlier studies have revealed that the more the preference to schedule daily activities towards the evening hours is, the higher the odds for a range of health hazards are. Therefore, we wanted to analyze, whether the behavioral trait of morningness-eveningness is associated with articular and spinal diseases or those with musculoskeletal disorders. Participants (n = 6089), as part of the National FINRISK 2007 Study, were derived from the general population, aged 25 to 74 years, living in Finland. Chronotype was assessed based on six items from the original Horne-Östberg Morningness-Eveningness Questionnaire. Information about risk factors and the diagnoses of articular and spinal diseases were based on the self-reported information. Our results suggest that Evening-types have higher odds for articular and spinal diseases as compared with Morning-types, and this risk is heightened especially regarding spinal disease and backache (odds ratios of 1.8 to 2.1, and 1.6 to 1.8, respectively) and remains significant after controlling for the sex, age, education, civil status, physical activity, alcohol use, and smoking, and additionally for the body-mass index, insufficient sleep, or depressive symptoms.

Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis

This article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables. Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥ 7) and 71 (22.5%) for anxiety (HADS-A score ≥ 10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety. Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the independent risk factor associated with depression but not anxiety in axSpA. These findings suggest that psychological status should be examined while assessing patients with axSpA including AS and nr-axSpA.

Patient preferences for psychological support in inflammatory arthritis: a multicentre survey

OBJECTIVES

Inflammatory arthritis (IA) can lead to anxiety, depression, pain and fatigue. Psychological support can improve quality of life and self-management; and European and American guidelines recommend support be offered. This study examined patient views on psychological support for their IA.

METHODS

A questionnaire designed by researchers, patient partners and clinicians was administered to 2280 patients with IA.

RESULTS

1210 patients responded (53%): 74% women; mean age 59 years (SD 12.7); patient global 5 (2.3); disease duration <5 years (41%), 5-10 (20%), >10 (39%). Only 23% reported routinely being asked about social and emotional issues by a rheumatology professional, but 46% would like the opportunity to discuss psychological impact. If offered, 66% of patients reported they would use a self-management/coping clinic (63% pain management, 60% occupational therapy, 48% peer support groups, 46% patient education, 46% psychology/counselling). Patients want support with managing the impact of pain and fatigue (82%), managing emotions (57%), work and leisure (52%), relationships (37%) and depression (34%). Preferences are for support to be delivered by the rheumatology team (nurse 74%, doctor 55%) and general practitioners (GPs) (51%). Only 6% of patients stated that social and emotional issues were not relevant.

CONCLUSIONS

Demand for psychological support is high; however, less than a quarter of patients reported being asked about social and emotional issues, suggesting a gap between needs and provision. The preference is for delivery from rheumatology clinicians and GPs, and research should establish whether they have the skills and resources to meet patients' needs.

Future perspectives of Smartphone applications for rheumatic diseases self-management

Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived self-efficacy. Despite these demonstrated good results, there are several issues that hinder or render less appealing these interventions. One economically and socially viable solution is exploiting the potential of Smartphone technology. This potential comes from Smartphones pervasive presence in actual society, combined with the advantages of being personal, intuitive, and computationally powerful, with capability to support applications and assist its user throughout different activities of daily living and environments persistently. With their global acceptance increasing quickly, there is a great opportunity for mobile health in using Smartphone applications for RD self-management. Besides the potential of such applications, research on the development and evaluation of such applications is in the early stages. Therefore, it is important to foresee its future applicability in order to meet the needs of the twenty-first century.

The risk for depression in patients with ankylosing spondylitis: a population-based cohort study

Introduction

Depression is frequent in ankylosing spondylitis (AS) patients. However, epidemiological data about the potential increase in risk are lacking. This study compares the rate of doctor-diagnosed depression in a well defined cohort of AS patients to the general population seeking care.

Methods

The Skåne Healthcare Register comprises healthcare data of each resident in Region Skåne, Sweden (population 1.2 million), including ICD-10 diagnoses. Using physician coded consultation data from years 1999 to 2011, we calculated depression consultation rates for all AS patients. We obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex-specific rates of depression in the general population seeking care. A ratio >1 equals a higher rate of depression among AS patients.

Results

The AS cohort consisted of 1738 subjects (65% men) with a mean age of 54 years. The reference population consisted of 967,012 subjects. During the 13-year observation period 10% (n = 172) of the AS cohort had a doctor-diagnosed depression compared to 6% (n = 105) to be expected. The standardized estimate of depression-rate ratio was 1.81 (95% confidence interval 1.44 to 2.24) in women men and 1.49 (1.20 to 1.89) in men.

Conclusions

The rate of doctor-diagnosed depression is increased about 80% in female and 50% in male AS patients. Future challenges are to timely identify and treat the AS patients who suffer from depression.

A survey of psychological support provision for people with inflammatory arthritis in secondary care in England

Objectives

The consequences of inflammatory arthritis can include depression, anxiety and low mood, reducing patients’ quality of life and increasing pressure on the healthcare system. Treatment guidelines recommend psychological support, but data are lacking on the provision available.

Methods

A postal survey concerning psychological support provision was sent to rheumatology units in 143 acute trusts across England. Nurses from 73 rheumatology units (51%) responded.

Results

Overall, 73% rated their unit's psychological support provision as ‘inadequate’ and only 4% rated it as ‘good’. Few units believed that psychological support did not fall within their remit (12%), yet only 8% had a psychologist in the team. Most units (68%) did not routinely screen patients to identify psychological difficulties. Referral to other service providers was reported in 42% of units, with 3% very satisfied with this provision. Within units, services containing elements of psychological support ranged from occupational therapy (81%) to psychology/counselling (14%). Psychological approaches used by team members ranged from shared decision making (77%) to cognitive–behavioural approaches (26%). The current barriers to providing psychological support were lack of clinical time and available training (86% and 74%, respectively), and delivery costs (74%). Future facilitators included management support (74%) and availability of skills training (74%).

Conclusions

Rheumatology units viewed psychological support provision as part of their remit but rated their overall provision as inadequate, despite some team members using psychological skills. To improve provision, clinicians’ training needs must be addressed and organizational support generated, and further research needs to define adequate psychological support provision from the patient perspective. © 2014 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.

Psychological therapies for the management of chronic pain

Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.

A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial

Background

A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention’s effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders’ analysis are planned.

Methods/design

The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition.

Discussion

The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life.

Trial registration

Nederlands Trial Register = NTR3606, registration date 11-09-2012.

An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases

OBJECTIVE

To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases.

METHODS

An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters.

RESULTS

Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients.

CONCLUSION

The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment.

PRACTICE IMPLICATIONS

A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation.