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Meade T, Joyce C, Perich T, Manolios N, Conaghan PG, Katz P. Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:171-180. [PMID: 37779491 DOI: 10.1002/acr.25245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Many studies have reported high rates of anxiety in adults with rheumatoid arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA. METHODS Six databases were searched from January 2000 without restrictions on language/location, study design, or gray literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardized self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesized via a narrative approach. RESULTS Across the 47 studies (n = 11,085 participants), the sample size ranged from 60 to 1,321 participants with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries, and anxiety prevalence ranged from 2.4% to 77%, predominantly determined with standardized self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life. CONCLUSION The reported prevalence of anxiety in RA varied widely potentially because of use of different self-report measures and cutoff points. Such cutoff points will need to be standardized to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.
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Affiliation(s)
- Tanya Meade
- Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline Joyce
- Western Sydney University, Sydney, New South Wales, Australia
| | - Tania Perich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phillip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Abd EL-Khalik DM, Eltohamy M. Evaluation of Depression and Anxiety in Rheumatoid Arthritis Patients During COVID-19 Pandemic. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2023; 16:11795441231216988. [PMID: 38115857 PMCID: PMC10729612 DOI: 10.1177/11795441231216988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
Background Rheumatoid arthritis (RA) disease activity, associated comorbidities, and therapy-related side effects impair the physical, social, and emotional dimensions of the patient's health. Presently, the ongoing COVID-19 pandemic has been associated with a broad range of psychosocial disorders in various populations. Patients with RA are especially vulnerable to such effects. Objectives Detect the prevalence of recent COVID-19 infection among patients with RA, assess depression and anxiety in these patients and their associated factors during the COVID-19 pandemic and their potential relation to disease activity. Design and Methods This is a cross-sectional study conducted on 120 adult Egyptian patients diagnosed with RA during the COVID-19 pandemic. The prevalence of recent COVID-19 infection among the patients was evaluated. The patients underwent psychological assessment using the Hamilton Depression Rating Scale (Ham-D) and the Hamilton Anxiety Rating Scale (Ham-A) to measure levels of depression and anxiety levels. The RA disease activity was assessed using Disease Activity Score (DAS) Das-28-ESR. Results This study encompasses a total of 120 RA patients. The prevalence of patients with a recent history of COVID-19 infection was 40.8%. Both groups exhibited significantly elevated mean scores on the Das-28-ESR scale and also scored higher on measures of depression and anxiety. Interestingly, the COVID-19 group exhibited a higher percentage of unmarried individuals, had educational attainment below the university level, and were unemployed. Patients with recent COVID-19 had significantly lower numbers of children, higher disease duration, higher Das-28-ESR scores, and elevated depression and anxiety scores. The statistical analysis revealed that the COVID-19 infection and disease duration were significant predictors of depression and anxiety. The results also exhibited that the depression score was positively correlated with age and DAS scores. Conclusions It was observed that patients diagnosed with RA revealed a higher prevalence of COVID-19 infection. The occurrence of depression and anxiety was observed to be widespread among patients diagnosed with RA and, more significantly, prevalent in RA patients who had a recent COVID-19 and had a higher level of disease activity. The occurrence of COVID-19 and disease duration were identified as factors that can anticipate the development of depression and anxiety.
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Affiliation(s)
- Dina M Abd EL-Khalik
- Internal Medicine Department, Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Internal Medicine Department, Rheumatology Division, Armed Forces College of Medicine, Cairo, Egypt
| | - Mohamed Eltohamy
- Psychiatry Department, Armed Forces College of Medicine, Cairo, Egypt
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Alharbi S. Depression in Saudi Patients with Rheumatoid Arthritis. Open Access Rheumatol 2023; 15:1-9. [PMID: 36726480 PMCID: PMC9885770 DOI: 10.2147/oarrr.s397489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
Purpose Depression is the most common psychiatric disorder associated with rheumatoid arthritis (RA). However, little is known about its prevalence and risk factors among Saudi patients, specifically. Therefore, this study sought to determine the prevalence and predictors of depression in patients with RA in Saudi Arabia. Patients and Methods A cross-sectional study was conducted with patients registered at the Saudi Charitable Association for Rheumatic Diseases. Inclusion criteria were that the patients either met the American College of Rheumatology 1987 revised criteria for the classification of RA or the 2010 RA classification criteria. Demographic data and clinical variables were collected, and Beck's 21-item Depression Inventory was used to assess for depression. Results Of the 210 participants with RA, 171 were women (81.4%), and 39 were men (18.6%). The prevalence of depression was 68%. There were significant relationships between age, gender, marital status, and having depression. Rheumatoid factor (RF) was positive in 144 participants (68.6%), which positively correlated with the risk of having depression (P value < 0.001). Moreover, depression severity correlated with age, gender, marital status, RF positivity, and prolonged disease duration. Conclusion Based on the results, depression is highly prevalent in Saudi patients with RA, especially those with positive RF and those who are female, middle-aged, and divorced. Early detection and treatment of depression in patients with RA is highly recommended to improve their quality of life and avoid unfavorable effects on RA clinical progression.
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Affiliation(s)
- Samar Alharbi
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia,Correspondence: Samar Alharbi, Department of Medicine, Taibah University, Medina, 42312-3779, Saudi Arabia, Tel +96 6553018777, Fax +96 648461172, Email
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Mena-Vázquez N, Rojas-Gimenez M, Romero-Barco CM, Gandía-Martínez M, Perez-Gómez N, Godoy-Navarrete FJ, Manrique-Arija S, Garcia-Studer A, Calvo-Gutiérrez J, Varela CF, Morales-Garrido P, Pérez PC, Mouriño-Rodriguez C, Añón-Oñate I, Espildora F, Aguilar-Hurtado MC, Redondo R, Conde AH, de Los Ríos RAD, César EC, Velloso-Feijoo ML, Fernández-Nebro A. Analysis of comorbidity in rheumatoid arthritis-associated interstitial lung disease: a nested case-cohort study. Biomed Pharmacother 2023; 157:114049. [PMID: 36459713 DOI: 10.1016/j.biopha.2022.114049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe comorbid conditions in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity. METHODS Nested case-cohort study of 2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD. RESULTS The final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 [72.7] vs 60 [57.7]; p = 0.021). In both groups, multimorbidity was associated with ILD (OR [95% CI] 1.92 [1.03-3.59]; p = 0.039), age (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004), CRP (OR [95% CI] 1.16 [1.05-1.29]; p = 0.003), and erosions (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004); in the cases, it was associated with CRP (OR [95% CI] 1.17 [1.01-1.35]; p = 0.027), anti-citrullinated peptide antibody (OR [95% CI] 1.23 [1.14-13.02]; p = 0.049), and forced vital capacity (OR [95% CI] 0.79 [0.96-0.99]; p = 0.036). CONCLUSION In patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
| | - Marta Rojas-Gimenez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Carmen María Romero-Barco
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Nair Perez-Gómez
- UGC de Reumatología, Complejo Hospitalario Universitario de Vigo, 36214 Vigo, Spain
| | | | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Jerusalem Calvo-Gutiérrez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Clara Fuego Varela
- UGC de Reumatología, Hospital Universitario de Jerez, 11407 Cádiz, Spain
| | - Pilar Morales-Garrido
- UGC de Reumatología, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | | | | | | | - Francisco Espildora
- UGC de Neumología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | | | - Rocío Redondo
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Ana Hidalgo Conde
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Eva Cabrera César
- UGC Neumología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
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Stanciu I, Anderson J, Siebert S, Mackay D, Lyall DM. Associations of rheumatoid arthritis and rheumatoid factor with mental health, sleep and cognition characteristics in the UK Biobank. Sci Rep 2022; 12:19844. [PMID: 36400784 PMCID: PMC9674828 DOI: 10.1038/s41598-022-22021-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Abstract
While previous rheumatoid arthritis (RA) studies have focussed on cardiometabolic and lifestyle factors, less research has focussed on psychological variables including mood and cognitive health, and sleep. Cross-sectional analyses tested for associations between RA and RF+ (positive rheumatoid factor) vs. mental health (depression, anxiety, neuroticism), sleep variables and cognition scores in UK Biobank (total n = 484,064). Those RF+ were more likely to report longer sleep duration (β = 0.01, SE = 0.004, p < 0.01) and less likely to get up in the morning easily (OR 0.95, 95% CI 0.92-0.99, p = 0.01). Those reporting RA were more likely to score higher for neuroticism (β = 0.05, SE = 0.01, p < 0.001), to nap during the day (OR 1.10, 95% CI 1.06-1.14, p < 0.001), have insomnia (OR 1.28, 95% CI 1.22-1.35, p < 0.001), have slower reaction times (β = 0.02, SE = 0.008, p < 0.005) and score less for fluid intelligence (β = - 0.03, SE = 0.01, p < 0.05) and less likely to get up easily (OR 0.61, 95% CI 0.58-0.64, p < 0.001). The current study suggests that prevalent RA, and RF+ status are associated with differences in mental health, sleep, and cognition, highlighting the importance of addressing these aspects in clinical settings and future research.
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Affiliation(s)
- Ioana Stanciu
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jana Anderson
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Stefan Siebert
- School of Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
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Hill J, Harrison J, Christian D, Reed J, Clegg A, Duffield SJ, Goodson N, Marson T. The prevalence of comorbidity in rheumatoid arthritis: a systematic review and meta-analysis. Br J Community Nurs 2022; 27:232-241. [PMID: 35522453 DOI: 10.12968/bjcn.2022.27.5.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This systematic review and meta-analysis estimates the prevalence of common comorbid health disorders in adults with rheumatoid arthritis (RA). A multi-database search strategy was undertaken. Screening, data extraction and quality assessment were carried out by two independent reviewers. A meta-analysis and meta-regression were used to generate a pooled prevalence estimate and identify relevant moderators. After study selection, 33 studies (74633 participants) were included in the meta-analysis. Some 31 studies were judged to be of low risk of bias, and two studies were judged to be at moderate risk of bias. The three most common comorbidities in RA were anxiety disorders (62.1%, 95% Cl: 43.6%; 80.6%), hypertension (37.7%, 95% Cl: 29.2%; 46.2%) and depression (32.1%, 95% Cl: 21.6%; 42.7%). There was substantial statistically significant heterogeneity for all comorbidities (I2 ≥77%). Meta-regression identified that the covariate of mean age (unit increase) had a statistically significant effect on the prevalence of hypertension (+2.3%, 95% Cl: 0.4%; 4.2%), depression (-0.5%, 95% Cl: -0.6%; -0.4%) and cancer (0.5%, 95% Cl: 0.2%; 0.8%) in adults with RA. A country's income was identified to have a statistically significant effect on the prevalence of depression, with low-to moderate-income countries having 40% (95% Cl: 14.0%; 66.6%) higher prevalence than high-income countries. No studies consider health inequalities. It is concluded that comorbidities are prevalent among people with RA, particularly those associated with mental health and circulatory conditions. Provision of health services should reflect the importance of such multimorbidity and the consequences for quality and length of life.
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Affiliation(s)
- James Hill
- Senior Research Fellow in Evidence Synthesis, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Joanna Harrison
- Research Fellow in Evidence Synthesis & Summary, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Danielle Christian
- Research Associate, Stroke Research Team, University of Central Lancashire
| | - Janet Reed
- Library Customer Services Manager, Heriot-Watt University, Edinburgh
| | - Andrew Clegg
- Professor of Health Services Research, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Stephen J Duffield
- Senior Analyst - Methods and Standards, National Institute for Health and Care Excellence, Manchester
| | - Nicola Goodson
- Consultant Rheumatologist and Senior Lecturer, University Hospital Aintree, Liverpool
| | - Tony Marson
- Professor of Neurology, University of Liverpool
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Silke L, Kirresh O, Sturt J, Lempp H. Development of the Rheumatoid Arthritis Distress Scale (RADS): a new tool to identify disease-specific distress in patients with Rheumatoid Arthritis. BMC Rheumatol 2021; 5:51. [PMID: 34782021 PMCID: PMC8594165 DOI: 10.1186/s41927-021-00220-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients with Rheumatoid Arthritis (RA) may experience psychological distress (depression, anxiety) in addition to their physical symptoms. People with RA may also experience disease-specific distress (DSD), related to the specific burden of living with their life-long condition. DSD is a patient reported outcome in several long-term conditions, including type 1 and 2 diabetes. The aims of this study were to determine whether DSD is experienced by people with RA, and if so, develop a Patient Reported Outcome Measure (PROM) to assess for DSD in people with RA. Methods A five-phased qualitative study was conducted which consisted of a secondary data analysis of 61 interviews of people with rheumatological disease (Phase 1), validation of findings via a Patient and Public Involvement (PPI) group of people with RA (n = 4) (Phase 2), item generation for a PROM (Phase 3) and establishing face and content validity of the PROM via PPI group (n = 4) and individual cognitive interviews (n = 9) of people with RA respectively (Phase 4 and 5). The final PROM was presented at a Patient Education Evening for patients with long-term rheumatological conditions, including RA, and carers. Results Five themes of rheumatological disease distress emerged from Phase 1, which were validated in the Phase 2 PPI group. After Phases 3–5, the Rheumatoid Arthritis Distress Scale (RADS) was formed of 39 items and 3 supplementary questions. Overall participants reported the content of the RADS to be clear and relevant, and that DSD is a valid concept in RA, distinct from other entities like clinical depression or anxiety. Conclusions DSD appears to be an important concept in RA. The 39-item RADS demonstrates acceptable face and content validity in this patient group. Further psychometric testing is needed. The RADS may be a useful tool for healthcare professionals to identify RA distress.
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Affiliation(s)
- Linda Silke
- Outpatient Physiotherapy Department, Mile End Hospital, Bancroft Rd, London, E1 4DG, UK.
| | - Othman Kirresh
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, Waterloo, London, SE1 8WA, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, Weston Education Centre, King's College London, 10, Cutcombe Road, London, SE5 9RJ, UK
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Blaney C, Hitchon CA, Marrie RA, Mackenzie C, Holens P, El-Gabalawy R. Support for a non-therapist assisted, Internet-based cognitive-behavioral therapy (iCBT) intervention for mental health in rheumatoid arthritis patients. Internet Interv 2021; 24:100385. [PMID: 33912401 PMCID: PMC8056225 DOI: 10.1016/j.invent.2021.100385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anxiety is common in patients with rheumatoid arthritis (RA) and associated with worse RA outcomes. This study assessed the feasibility and preliminary health impacts (mental and physical) of a non-therapist assisted, online mental health intervention targeting anxiety in this population. METHODS Participants with confirmed RA and elevated anxiety symptoms were enrolled into the Worry and Sadness program, an Internet-based cognitive-behavioral therapy (iCBT) intervention for anxiety and depression shown to be effective in the general population. Validated self-report measures of anxiety, depression, pain interference, fatigue, physical health-related quality of life, functional status, and patient-reported disease severity were collected at baseline, post-intervention, and at three-month follow-up. Emotional distress scores were tracked between lessons. Participants provided qualitative feedback in writing post-intervention. RESULTS We analyzed the responses of 34 participants; the majority was female (86%) and the mean age was 57 (SD = 13). Of these, 80% (n = 28) completed the study in its entirety. Among these completers, 94.1% described the program as worthwhile. We found statistically significant improvements in anxiety, depression and fatigue from baseline to three-month follow-up, with small to large effect sizes (d = 0.39-0.81). Post-hoc analyses revealed that statistically significant change occurred between baseline and post-intervention for anxiety and depression and was maintained at three-month follow-up, whereas statistically significant change occurred between baseline and three-month follow-up for fatigue. Statistically significant reductions in emotional distress occurred across the program, with a large effect size (d = 1.16) between the first and last lesson. CONCLUSION The Worry and Sadness program shows promise as a feasible resource for improving mental health in RA.
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Affiliation(s)
- Caitlin Blaney
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada
| | - Carol A. Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey Mackenzie
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
| | - Pamela Holens
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba R3T 2N2, Canada
- Corresponding author at: AE-2, Harry Medovy House, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
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Lopes FHA, Freitas MVC, de Bruin VMS, de Bruin PFC. Depressive symptoms are associated with impaired sleep, fatigue, and disease activity in women with rheumatoid arthritis. Adv Rheumatol 2021; 61:18. [PMID: 33726867 DOI: 10.1186/s42358-021-00176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/02/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate the associations between sleep quality, fatigue, disease activity and depressive symptoms in women with rheumatoid arthritis (RA). METHODS Female patients with previous diagnosis of RA from a Rheumatology Outpatient Clinic at a tertiary referral centre, in Fortaleza, Brazil, were consecutively recruited into the study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); fatigue by the Fatigue Severity Scale (FSS); daytime sleepiness by the Epworth Sleepiness Scale (ESS); and depressive symptoms by the Beck Depression Inventory II (BDI-II). RA activity was measured by the disease activity score (DAS28). RESULTS One hundred ten women (mean age ± SD = 51.1 ± 13.0 y) were included in the study. On average, patients with depressive symptoms (BDI-II > 13), as compared to those without, showed poorer sleep quality (PSQI: 10.09 ± 4.1 vs 7.33 ± 3.55; p = 0.001 respectively), more fatigue (FSS: 4.69 ± 1.89 vs 3.34 ± 1.8; p = 0.001) and higher disease activity level (DAS28: 4.36 ± 1.53 vs 3.7 ± 1.39; p = 0,047). The logistic regression analysis showed that sleep quality is an independent predictor of depressive symptom severity. CONCLUSION Depressive symptoms, impaired sleep and fatigue are common in women with RA. Poor sleep is associated with greater frequency and severity of depressive symptoms in these patients, suggesting that screening for sleep and mood problems may be relevant both in clinical research and routine patient care. Future studies investigating the impact of measures to promote healthy sleep on depressive symptom control in this patient population are warranted.
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Affiliation(s)
- Fernando Henrique Azevedo Lopes
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Federal University of Ceara, Rua Prof. Costa Mendes 1608 - 4° andar, CEP 60430-971, Fortaleza, Ceara, Brazil
| | | | - Veralice Meireles Sales de Bruin
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Federal University of Ceara, Rua Prof. Costa Mendes 1608 - 4° andar, CEP 60430-971, Fortaleza, Ceara, Brazil
| | - Pedro Felipe Carvalhedo de Bruin
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Federal University of Ceara, Rua Prof. Costa Mendes 1608 - 4° andar, CEP 60430-971, Fortaleza, Ceara, Brazil.
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Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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11
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Saad RB, Fazaa A, Rouached L, Miladi S, Ouenniche K, Souabni L, Kassab S, Chekili S, Abdelghani KB, Laatar A. Sexual dysfunction and its determinants in women with rheumatoid arthritis. Z Rheumatol 2020; 80:373-378. [PMID: 32990787 DOI: 10.1007/s00393-020-00890-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to examine factors that are predictors of female sexual dysfunction including sociocultural factors, disease activity, and psychological status. METHODS We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria. Clinical and sociodemographic characteristics were collected. The participants were asked to complete the Female Sexual Function Index (FSFI), which contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. Sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The psychosocial status was evaluated by the Hospital Anxiety and Depression (HAD) scale. Prevalence of sexual dysfunction and predictors of sexual difficulties were assessed. RESULTS The prevalence of female sexual dysfunction in women with RA was 49.3%. All areas were altered especially desire (2.92 ± 1.3), arousal (3.27 ± 1.5), and orgasm (3.77 ± 1.5). In univariate analysis, sexual dysfunction was correlated with the age of patients (p = 0.049), the age of partners (p = 0.013), pain (p = 0.001), number of night awakenings (p = 0.02), morning stiffness (p = 0.010), tender joints (p = 0.05), disease activity score (DAS28 ESR) (p = 0.043), fatigue (p = 0.028), and Health assessment questionnaire (HAQ) (p = 0.02). In multivariate analysis, the age of patients and pain were predictive factors of sexual dysfunction. By analyzing each area of the FSFI score, the age of patients was the independent variable associated with desire. Tender joints were associated with lubrication and the age of partners with arousal, orgasm, and satisfaction. CONCLUSION Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.
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Affiliation(s)
- R B Saad
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - A Fazaa
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - L Rouached
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia. .,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - S Miladi
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - K Ouenniche
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - L Souabni
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - S Kassab
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - S Chekili
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - K B Abdelghani
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - A Laatar
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.,Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
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12
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Chaurasia N, Singh IL, Singh T, Tiwari T, Singh A. Effect of depression on attentional network system among rheumatoid arthritis patients-A cross-sectional study. J Family Med Prim Care 2020; 9:1974-1980. [PMID: 32670950 PMCID: PMC7346935 DOI: 10.4103/jfmpc.jfmpc_1161_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 12/21/2019] [Accepted: 02/19/2020] [Indexed: 11/30/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, painful and debilitating musculoskeletal condition with depression being its common co-morbidity. It is associated with symptoms of fatigue, pain, and sleep disturbances that can overlap with or mimic symptoms of depression. It may occur with at least mild severity is up to 42% of RA patients. Basically, depression refers to a constellation of experience including not only mood but also physical, mental and behavioral experiences. The fact that rates of depression are higher in samples of patients with RA than in the normal population is well documented. The present study was conducted in order to examine the effect of depression on attentional functioning with diagnosed RA patients. Twenty RA patients out of which 10 patients with depression and 10 patients without depression participated in the study. The Beck Depression Inventory was administered for the assessment of depression and the attentional network task was used to measure the attentional performance of the RA patients. Results revealed that there was a significant difference in depressive symptoms among RA patients on accuracy and reaction time (P < 0.01) and orienting effect (P < 0.05). The findings would also imply intervention and rehabilitation of depression among RA patients.
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Affiliation(s)
- Neha Chaurasia
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Indramani L Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tara Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Trayambak Tiwari
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anup Singh
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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13
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Hitchon CA, Zhang L, Peschken CA, Lix LM, Graff LA, Fisk JD, Patten SB, Bolton J, Sareen J, El-Gabalawy R, Marriott J, Bernstein CN, Marrie RA. Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1130-1139. [PMID: 31199570 PMCID: PMC7496677 DOI: 10.1002/acr.24011] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
Abstract
Objective To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis (RA). Methods Participants with RA completed the Patient Health Questionnaire (PHQ‐2 or PHQ‐9), the Patient Reported Outcomes Measurement Information System depression short form 8a and anxiety short form 8a, the Hospital Anxiety and Depression Scale anxiety score (HADS‐A) and depression score (HADS‐D), the Overall Anxiety Severity and Impairment Scale, the Generalized Anxiety Disorder 2‐ and 7‐item scales, and the Kessler‐6 scale. Clinical depression and anxiety disorders were confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders (SCID‐1) research version. We reported sensitivity, specificity, positive predictive value, and negative predictive value using SCID‐1 diagnoses as the criterion standard. Test–retest reliability was assessed with the intraclass correlation coefficient. Results Of 150 participants, 11.3% had SCID‐1–diagnosed depression, 7.3% had SCID‐1–diagnosed generalized anxiety disorder, and 19.3% had any SCID‐1–diagnosed anxiety disorder. For depression, sensitivity ranged from HADS‐D (cut point 11; 35%) to PHQ‐2 (88%) and PHQ‐9 (87%). Specificity ranged from PHQ‐9 (77%) and PHQ‐2 (84%) to HADS‐D (cut point 11; 94%). Positive predictive value ranged from 30% to 43%. Negative predictive value ranged from 92% to 98%. For generalized anxiety disorder, sensitivity ranged from HADS‐A (cut point 11; 45%) to HADS‐A (cut point 8; 91%). Specificity ranged from 81% to 89% for all measures except the HADS‐A (cut point 8; 63%). Intraclass correlation coefficient estimates ranging from 0.69 to 0.88 confirmed good test–retest reliability. Conclusion Depression screening instruments had good diagnostic performance; anxiety instruments were more variable. Identified depression and anxiety require clinical confirmation.
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Affiliation(s)
- Carol A Hitchon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lixia Zhang
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A Peschken
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott B Patten
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Bolton
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Marriott
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Chaurasia N, Singh A, Singh IL, Singh T, Tiwari T. Cognitive dysfunction in patients of rheumatoid arthritis. J Family Med Prim Care 2020; 9:2219-2225. [PMID: 32754477 PMCID: PMC7380780 DOI: 10.4103/jfmpc.jfmpc_307_20] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid Arthritis (RA) is a form of arthritis characterized by joint pain, stiffness, swelling and deformity. There has been plethora of researches in the area of rheumatoid arthritis which focused on immune system, genetic predisposition and newer treatment modalities. Researchers have also examined the cognitive decline, physical deficits and their interrelationship in patients with RA. Among several psychological aspects depression, anxiety and stress emerge as significant psychological co morbidity. RA is a multifactorial, chronic, inflammatory disease primarily affects physical functioning as well as psychological aspects. Pain, fatigue, duration of disease, disease activity and functional disability are very common in rheumatoid arthritis which is leading cause of psychological distress and functional disability. Various types of neuropsychological battery were used to assess the decline in specific areas like attention, executive functioning, visuo-spatial learning, verbal learning/memory etc. These functions were compared with other type of arthritis disease. Also, various other factors like depression, cardiovascular diseases, other systemic and chronic disease and concomitant drugs intake etc. also affected cognitive functioning in Rheumatoid Arthritis patients. The objective of this review was to identify and explore the rates and types of cognitive impairment in RA. This present review paper systematically examines and summarizes the cognition related decrement in arthritis patients. Multiple research articles between 1990 to 2018 were searched. These reviews were evaluated and synthesized using a narrative and descriptive approach.
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Affiliation(s)
- Neha Chaurasia
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anup Singh
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Indramani L Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tara Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Trayambak Tiwari
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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15
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Ng KJ, Huang KY, Tung CH, Hsu BB, Wu CH, Lu MC, Lai NS. Risk factors, including different biologics, associated with depression and anxiety in patients with rheumatoid arthritis: a cross-sectional observational study. Clin Rheumatol 2019; 39:737-746. [PMID: 31823143 DOI: 10.1007/s10067-019-04820-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To evaluate the associated factors of depression and anxiety in patients with rheumatoid arthritis (RA) and examine the effect of different biologics. METHODS This cross-sectional study was conducted in a regional hospital in southern Taiwan from August of 2017 to April of 2018. A total of 625 patients with RA were included. RA disease activity was measured with Disease Activity Score over 28 joints based on erythrocyte sedimentation rate (DAS28-ESR). Depression and anxiety were measured with Hospital Anxiety and Depression Scale (HADS). RESULTS Based on HADS scores, 38 subjects (6.1%) and 15 subjects (2.4%) were classified as depression and anxiety, respectively. Increased disease activity of RA is noted in RA patients with depression or anxiety, and among the items of DAS28-ESR, only the two subjective components: tender joint count over 28 joints (TJC28) and patient's global assessment (PGA) were significantly different. Multiple logistic regression analysis indicated that depression was significantly associated with TJC28 (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI] 1.05-1.14) and female (aOR = 5.43, 95% CI 1.25-23.52); and anxiety was associated with TJC 28 (aOR = 1.07, 95% CI 1.00-1.15) and PGA (aOR = 1.03, 95% CI 1.01-1.06). Secondary analysis found a significantly lower risk of depression (aOR = 0.20, 95% CI 0.04-0.88) in patients receiving etanercept, but not anxiety, when compared with the non-biologic group. CONCLUSIONS This study suggests that only subjective components of DAS28-ESR were significantly associated with depression and anxiety. In comparison with other biologics, patients receiving etanercept appeared to have a lower risk of depression.Key Points• Rheumatoid arthritis patients possessed higher risk of depression and anxiety.• Both depression and anxiety are strongly correlated with the subjective components of DAS28-ESR.• Etanercept might be the choice of biologics in rheumatoid arthritis patients with depression.
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Affiliation(s)
- Khai-Jing Ng
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan.,Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan.,Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
| | - Kuang-Yung Huang
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan.,Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan.,Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
| | - Chien-Hsueh Tung
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan.,Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan.,Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
| | - Bao-Bao Hsu
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
| | - Cheng-Han Wu
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
| | - Ming-Chi Lu
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan. .,Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan. .,Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan. .,Department of Medical Research, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan.
| | - Ning-Sheng Lai
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan. .,Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan. .,Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan.
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16
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Rheumatoid arthritis and risk of anxiety: a meta-analysis of cohort studies. Clin Rheumatol 2019; 38:2053-2061. [PMID: 30924010 DOI: 10.1007/s10067-019-04502-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022]
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Mental Health and Rheumatoid Arthritis: Toward Understanding the Emotional Status of People with Chronic Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1473925. [PMID: 30886858 PMCID: PMC6388315 DOI: 10.1155/2019/1473925] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/22/2019] [Indexed: 11/17/2022]
Abstract
Introduction Rheumatoid arthritis (RA) is a long-term disorder significantly impairing the somatic, emotional, and psychological functioning of its sufferers. Previous research has shown that affected individuals are characterized by an increased level of anxiety and depression. Currently, there are two main treatment schemes for RA; the first uses anti-inflammatory drugs, and the second utilizes biologic agents. This begs the question whether sufferers differ in intensities of pain, anxiety, and depression depending on the type of treatment and what the determinants of these affective states in patients treated using different methods are. Methods The study comprised 85 patients affected by RA (including 57 receiving biologically inactive medication). Research participants filled out a set of questionnaires measuring levels of anxiety and depression, intensity of experienced pain, strategies of coping with pain, and ego resiliency. Results The collected data was analyzed through intergroup comparisons, calculating simple correlation coefficients, developing and solving regression equations. The results imply that the choice of treatment differentiates the intensity of pain experienced by patients. Those receiving biologic agents reported lower levels of pain compared to those taking anti-inflammatory medication. It has also been noted that there are distinct configurations of conditions conducive to anxiety and depression in both anti-inflammatory and biologic agent groups. Discussion The observed constellation of dependencies between variables indicates that the choice of treatment scheme differentiates pain levels. This confirms the assumption that pain intensity, coping strategies, and ego resiliency depend on the severity of anxiety and depression.
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Babu AR, Sreedevi A, John A, Krishnapillai V. Prevalence and Determinants of Somatization and Anxiety among Adult Women in an Urban Population in Kerala. Indian J Community Med 2019; 44:S66-S69. [PMID: 31728095 PMCID: PMC6824177 DOI: 10.4103/ijcm.ijcm_55_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Common mental disorders (CMDs) such as somatization and anxiety are prevalent in general practice. These are twice more common in women. Objectives The objective of this study is to estimate the prevalence and determinants of somatization and anxiety among adult women in an urban population of Kochi. Materials and Methods A cross-sectional study was conducted among 1210 adult women of Kochi in 2016-2017. The Patient Health Questionnaire-15; the Generalized Anxiety Disorder-7 questionnaire; the Hurt, Insult, Threaten, and Scream tool; and a semi-structured questionnaire were used to estimate the prevalence of somatization and anxiety. Descriptive statistics and univariate and multivariate analysis were done for factors associated with CMDs. Results Most of the respondents were married (77.7%), with a mean age of 45.24 ± 15.59. In the current study, 40.8% (95% confidence interval [CI] =38.09-43.62) had somatization and 23.9% (95% CI = 21.57-26.37) had anxiety disorders. In the final logistic regression model, hypertension, perception of illness, positive family history of mental illness, and arthritis were the four determinants common to somatization and anxiety. Menstrual problems (odds ratio [OR] =3.19; 95% CI = 1.12-5.9), cardiac illness (OR = 2.31; 95% CI = 1.08-4.9), and history of major surgeries (OR = 1.62; 95% CI = 1.14-2.41) were independent determinants of somatization. The status of being single (OR = 1.71; 95% CI = 1.25-2.32), adverse life circumstances (OR = 5.85; 95% CI = 3.98-8.6), diabetes (OR = 2.04; 95% CI = 1.25-3.34), sleep problems (OR = 1.64; 95% CI = 1.77-2.91), and history of drug use (OR = 4.89; 95% CI = 1.92-12.46) were independent determinants of anxiety. Conclusion Mental health services for urban women deserve immediate attention as the prevalence of somatization and anxiety is high. Hence, it is important to screen for somatization and anxiety among women with noncommunicable diseases.
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Affiliation(s)
| | - Aswathy Sreedevi
- Community Medicine, Amrita Vishwa Vidyapeetham, AIMS, Kochi, Kerala, India
| | - Alexander John
- Department of Community Medicine, SNIMS, Ernakulam, Kerala, India
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Senara SH, Abdel Wahed WY, Mabrouk SE. Importance of patient education in management of patients with rheumatoid arthritis: an intervention study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_31_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Brooks JM, Titus AJ, Polenick CA, Orzechowski NM, Reid MC, MacKenzie TA, Bartels SJ, Batsis JA. Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey. Int J Geriatr Psychiatry 2018; 33:1671-1679. [PMID: 30229563 PMCID: PMC6422526 DOI: 10.1002/gps.4971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. METHODS Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted. RESULTS Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis. CONCLUSIONS Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,University of North Texas, Denton, TX, USA
| | - Alexander J. Titus
- Program in Quantitative Biomedical Sciences, Dartmouth College, Lebanon, NH, USA,Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Nicole M. Orzechowski
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Todd A. MacKenzie
- Biomedical Data Science, Dartmouth College, Lebanon, NH, USA,Department of Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
| | - John A. Batsis
- Department of Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
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The Patient-Reported Outcomes Thermometer-5-Item Scale (5T-PROs): Validation of a New Tool for the Quick Assessment of Overall Health Status in Painful Rheumatic Diseases. Pain Res Manag 2018; 2018:3496846. [PMID: 30425755 PMCID: PMC6218716 DOI: 10.1155/2018/3496846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 09/30/2018] [Indexed: 12/23/2022]
Abstract
Objective To investigate the construct validity, reliability (internal consistency and retest reliability), and feasibility of the patient-reported outcomes thermometer–5-item scale (5T-PROs), a new tool to measure overall health status in patients with painful chronic rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axialSpA), and fibromyalgia (FM). Methods Consecutive patients have been involved in this study. The following analyses were performed to establish the validity of the 5T-PROs: (1) principal component factor analysis was used to identify the presence of a relatively small number of underlying latent factors than can be used to represent relations among sets of many variables; (2) Cronbach's alpha was calculated as an indicator of internal consistency; and (3) Pearson product-moment correlations were conducted to assess the convergent validity. The 5T-PROs was also administered a second time (two weeks after the initial administration) to a subset of sample (n = 426) to allow for calculation of test-retest reliability. We used the intraclass correlation coefficient (ICC) as an estimate of test-retest reliability. Additionally, discriminant validity was tested using analysis of variance (ANOVA) with Bonferroni post hoc multiple comparisons, in different disease conditions. Feasibility was analyzed by the time taken in completing the 5T-PROs and the proportion of patients able to complete the 5 item. Results 1,199 patients (572 with RA, 251 with axialSpA, 150 with PsA, and 226 with FM) were examined. The mean age was 55.7 (standard deviation: 13.1; range: 20 to 80) years. Factor analysis yielded two factors which accounted for 62.54% of the variance of the 5T-PROs. The first factor “Symptom Summary Score” (35.57% of the variance) revealed a good internal consistency (alpha = 0.88); the internal consistency of the second factor “Psychological Summary Score” (26.97% of the variance) was moderate (alpha = 0.69). The reliability of the whole instrument was good (alpha = 0.82). A very high correlation was obtained between Symptom Summary Score and SF-36 PCS and between pain thermometer intensity and SF-36 bodily pain. For all five items and summary scale scores of the SF-36, there was strong evidence that the mean rank of the scores differs significantly between the groups (Kruskal–Wallis tests, p < 0.001). Discriminant validity, assessed by comparing the 5T-PRO dimensions in patients with different states of disease activity, showed that the 5T-PROs show moderate association with the presence of comorbidities. It was also noted that it was inversely correlated (p=0.01) to years of formal education. Conclusion The 5T-PROs is easily administered, reliable and a valid instrument for evaluating the extensive multidimensional impact associated with chronic painful rheumatic conditions.
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Pehlivan Y, Orucoglu N, Pehlivan S, Kimyon G, Zengin O, Kucuk A, Sahin A, Tomas N, Oksuz MF, Kisacik B, Akar S, Onat AM, Dalkilic E. Patients' concerns regarding biological agents in rheumatology. Int J Rheum Dis 2018; 21:1219-1226. [PMID: 29879318 DOI: 10.1111/1756-185x.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The potential side effects of biological agents may increase the anxiety levels of patients and influence not only their desire to use these therapies but also their concordance to treatment. This study aimed to determine the level and prevalence of drug-related concern in patients treated with biological agents and to acquire additional information regarding the related causes. MATERIALS AND METHODS A total of 1134 patients who were using biological agents for at least 3 months with a diagnosis of rheumatic diseases were enrolled. General anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI). RESULTS The most common cause for drug-related concerns was the potential side effects of the drugs (59.5%). Among the potential side effects, cancer risk was the most common cause for concern (40.1%), followed by the risk of tuberculosis activation (30.7%). Anxiety levels were higher in patients who experienced side effects than in other patients, and this difference was statistically significant (P < 0.05). STAI trait and state scores were moderately correlated with anxiety levels related to the drug (P < 0.001). CONCLUSION Anxiety related to biological agents may significantly affect the patients' anxiety levels. Awareness regarding the patients' concerns and expectations related to the drug is important to ensure drug adherence and concordance to treatment.
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Affiliation(s)
- Yavuz Pehlivan
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Nurdan Orucoglu
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Seda Pehlivan
- Department of Nursing, Health Science Faculty, Uludag University, Bursa, Turkey
| | - Gezmis Kimyon
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Orhan Zengin
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Adem Kucuk
- Department of Rheumatology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Sahin
- Department of Rheumatology, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Nazmiye Tomas
- Department of Rheumatology, School of Medicine, İzmir Katip Celebi University, İzmir, Turkey
| | - Mustafa Ferhat Oksuz
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Bunyamin Kisacik
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Servet Akar
- Department of Rheumatology, School of Medicine, İzmir Katip Celebi University, İzmir, Turkey
| | - Ahmet Mesut Onat
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ediz Dalkilic
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
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A population-based examination of the co-occurrence and functional correlates of chronic pain and generalized anxiety disorder. J Anxiety Disord 2018; 56:74-80. [PMID: 29703452 DOI: 10.1016/j.janxdis.2018.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to: 1) Establish the prevalence of co-occurring chronic pain conditions (i.e., arthritis, back pain, and migraines) and generalized anxiety disorder (GAD), and 2) Examine levels of pain severity, disability, and work absenteeism among comorbid chronic pain conditions and GAD. METHODS Data were analyzed from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH; N = 25,113). Chi-square analyses assessed whether significant differences existed in pain severity in those with comorbid chronic pain and GAD versus pain conditions alone. Multivariable regressions examined the association between comorbid chronic pain and GAD with functional outcomes. RESULTS The weighted prevalence of GAD among those with chronic migraines, arthritis and back pain was 6.9%, 4.4%, and 6.1% respectively, compared to 2.6% among the entire sample. Severity of pain was increased among those with comorbid chronic pain and GAD compared with chronic pain conditions alone. Migraine was the only pain condition that was significantly associated with disability in our most stringent adjustment model. After controlling for other psychiatric disorders, comorbid GAD and chronic pain was not associated with work absenteeism. CONCLUSION Chronic pain is common among the Canadian population and is associated with substantial disability. Results demonstrated that GAD is prevalent among chronic pain conditions, and comorbidity is associated with greater pain severity. GAD in the context of migraines, in particular, may represent an important treatment target to reduce disability.
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Withers MH, Gonzalez LT, Karpouzas GA. Identification and Treatment Optimization of Comorbid Depression in Rheumatoid Arthritis. Rheumatol Ther 2017; 4:281-291. [PMID: 28815445 PMCID: PMC5696284 DOI: 10.1007/s40744-017-0072-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) suffer from high rates of depression but depression often remains undiagnosed and untreated among RA patients. Because of its high prevalence and its profound impact on functional disability and health-related quality of life, prompt recognition and management of comorbid depression is urgently needed in patients with RA. Rheumatologists face the challenge of addressing depression in their clinical interactions with patients. The purpose of this paper is to present the prevalence of comorbid depression in RA, to delineate the consequences of depression among RA patients, to discuss the barriers to the identification of depression among RA patients, and to outline a set of recommendations to identify and treat comorbid depression that could be implemented within the rheumatology clinic setting. A comprehensive approach to the management of both physical and mental health needs of RA patients can aid in improving patient overall quality of life. New clinical protocols should be developed to include routine depression screening as part of the rheumatology visit. Patient education to address misconceptions, knowledge gaps, and destigmatize depression is also recommended. More counseling resources, including emotional support groups, are necessary to provide treatment for those suffering from depression. Such interventions could help mitigate disability, improve quality of life, patient function, and overall satisfaction.
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Affiliation(s)
- Mellissa H Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Louella T Gonzalez
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Fu X, Li ZJ, Yang CJ, Feng L, Sun L, Yao Y, Huang YT. The prevalence of depression in rheumatoid arthritis in China: A systematic review. Oncotarget 2017; 8:53623-53630. [PMID: 28881836 PMCID: PMC5581135 DOI: 10.18632/oncotarget.17323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/20/2017] [Indexed: 12/30/2022] Open
Abstract
This systematic review is to explore the prevalence of depression in patients with rheumatoid arthritis (RA) in China. Articles of prevalence rates for depression in adult RA patients published before October 2015 were identified from PubMed, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang database and other internet databases. Relevant journals and the recommendations of expert panels were also searched manually. Two independent reviewers searched and assessed the literature. Therelevant data were applied with Meta-Analyst 3.13 software, and the forest plot and funnel plot were performed. 21 studies with a total of 4447 patients were selected to be enrolled in this study. The prevalence of depression by analyzing the effect size was 48% [95% CI (41%, 56%)]. The prevalence of minor depression and dysthymic disorder was 30% [95%CI (23%, 38%)], and the moderate or major depression was 18% [95%CI (11%, 29%)], respectively. Subgroup analysis showed that the depression rate of female RA patients was higher than male. The depression rate in the central and western areas were higher than that of the eastern region of China, the prevalence level estimated by the Geriatric Depression Scale (GDS) was higher than estimated by other tools. Sensitivity analysis showed that the pooled effect size had good stability and reliability, To be conclusive, the prevalence rate of depression in RA patients is 48%, which suggesting that medical staff should pay more attention to depression in adult patients with RA.
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Affiliation(s)
- Xin Fu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Zhi-Jun Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chun-Jun Yang
- Department of Nursing, Tianjin Medical University General Hospital, Tianjin, China
| | - Liangshu Feng
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, China
| | - Lemeng Sun
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Yang Yao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu-Ting Huang
- Children's Research Institute, Children's National Medical Center, Washington, DC, USA
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Watad A, Bragazzi NL, Adawi M, Aljadeff G, Amital H, Comaneshter D, Cohen AD, Amital D. Anxiety disorder among rheumatoid arthritis patients: Insights from real-life data. J Affect Disord 2017; 213:30-34. [PMID: 28188994 DOI: 10.1016/j.jad.2017.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychiatric disorders occur in a considerable proportion of patients with rheumatoid arthritis (RA), often reflecting the difficulties of these patients in coping with a chronic debilitating disorder. AIM OF THE STUDY To evaluate the proportion of anxiety disorder in RA patients using a large database analysis. METHODS The study was designed as a case-control population-based study using data from the Clalit Health Services (CHS) database. Patients were defined as having RA or anxiety disorder when there was at least one documented diagnosis identified by the International Classification of Diseases-9 (ICD-9) from the medical records. The proportion of anxiety disorder was compared between RA patients and controls. A logistic regression model was used to estimate the association between RA and anxiety disorder in a multivariate analysis adjusted for age, gender and socioeconomic status (SES). RESULTS The study included 11,782 patients with RA and 57,973 age- and sex-frequency matched controls. The proportion of anxiety in RA patients was higher than in controls (7.1% vs 6.3%, p=0.001). In multivariate analysis, RA was found to be independently associated with anxiety (OR 1.11 [95%CI 1.03-1.20], p=0.01). Our study has some shortcomings, as its cross-sectional nature does not allow to make inferences about a causal relationship between RA and anxiety. CONCLUSION Our study confirms the higher proportion of anxiety in RA patients, especially young women with low SES. Physicians should be aware of such findings and, therefore, apply proper screening strategies.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Nicola L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Mohammad Adawi
- Padeh and Ziv hospitals, Bar-Ilan, Faculty of Medicine, Zefat, Israel
| | - Gali Aljadeff
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Doron Comaneshter
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Daniela Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Ness Ziona-Beer Yaacov Mental Health Center, Beer-Yaacov, Israel
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Sambamoorthi U, Shah D, Zhao X. Healthcare burden of depression in adults with arthritis. Expert Rev Pharmacoecon Outcomes Res 2017; 17:53-65. [PMID: 28092207 PMCID: PMC5512931 DOI: 10.1080/14737167.2017.1281744] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/10/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Arthritis and depression are two of the top disabling conditions. When arthritis and depression exist in the same individual, they can interact with each other negatively and pose a significant healthcare burden on the patients, their families, payers, healthcare systems, and society as a whole. Areas covered: The primary objective of this review is to summarize, identify knowledge gaps and discuss the challenges in estimating the healthcare burden of depression among individuals with arthritis. Electronic literature searches were performed on PubMed, Embase, EBSCOhost, Scopus, the Cochrane Library, and Google Scholar to identify relevant studies. Expert Commentary: Our review revealed that the prevalence of depression varied depending on the definition of depression, type of arthritis, tools and threshold points used to identify depression, and the country of residence. Depression exacerbated arthritis-related complications as well as pain and was associated with poor health-related quality of life, disability, mortality, and high financial burden. There were significant knowledge gaps in estimates of incident depression rates, depression attributable disability, and healthcare utilization, direct and indirect healthcare costs among individuals with arthritis.
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Affiliation(s)
- Usha Sambamoorthi
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
| | - Drishti Shah
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
| | - Xiaohui Zhao
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
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El-Gabalawy R, Mackenzie CS, Sareen J. Mental health service use among older Canadians with anxiety and comorbid physical conditions. Aging Ment Health 2017; 20:627-36. [PMID: 25897560 DOI: 10.1080/13607863.2015.1033678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to understand the relationship between mental health service use and comorbid any anxiety and commonly occurring physical conditions (i.e., arthritis, cardiovascular disease, and gastrointestinal disease) in a national sample of older Canadians. METHODS The sample consisted of older adults aged 55 years and older from the Canadian Community Health Survey 1.2 (N = 12,792). Trained lay interviewers assessed mental disorders based on Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) criteria. Physical conditions were based on self-reported diagnoses by health professionals. Past-year mental health service use was categorized into whether services were utilized in the general or specialty sectors. Crosstabulations and multiple logistic regressions examined the effects of both anxiety and physical conditions on mental health service use within the general and specialty mental health sectors. RESULTS Adjusted logistic regressions indicated that there was no effect of anxiety among older adults with gastrointestinal disease on mental health service use. Conversely, in adjusted regressions, having a comorbid anxiety disorder with cardiovascular disease or arthritis was associated with increased odds of service use from the general sector in comparison to cardiovascular disease and arthritis, respectively, alone. Additionally, older adults with comorbid any anxiety disorder and gastrointestinal disease in comparison to anxiety alone had lower rates of seeking mental health services; however, these effects were no longer significant in an adjusted model. CONCLUSION Comorbidity between gastrointestinal conditions and anxiety was associated with unmet mental health service needs. This may be conceptualized in the context overlapping symptomatology in gastrointestinal conditions and anxiety.
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Affiliation(s)
- Renée El-Gabalawy
- a Department of Psychology , University of Manitoba , Winnipeg , Canada
| | - Corey S Mackenzie
- a Department of Psychology , University of Manitoba , Winnipeg , Canada
| | - Jitender Sareen
- a Department of Psychology , University of Manitoba , Winnipeg , Canada.,b Department of Psychiatry , University of Manitoba , Winnipeg , Canada.,c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Liu L, Xu N, Wang L. Moderating role of self-efficacy on the associations of social support with depressive and anxiety symptoms in Chinese patients with rheumatoid arthritis. Neuropsychiatr Dis Treat 2017; 13:2141-2150. [PMID: 28860771 PMCID: PMC5558879 DOI: 10.2147/ndt.s137233] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Rheumatoid arthritis (RA) is significantly associated with depression and anxiety. Social support and self-efficacy are the coping resources of psychological distress. However, little research is available on the interaction of social support and self-efficacy in RA patients. This study aimed to identify the prevalence of depressive and anxiety symptoms and to examine whether or not self-efficacy moderates the associations of social support with depressive and anxiety symptoms in Chinese RA patients. METHODS A multicenter, cross-sectional study was conducted in northeast of China from December 2014 to January 2016. A total of 297 RA patients completed the Center for Epidemiologic Studies Depression Scale, Zung Self-Rating Anxiety Scale, Multidimensional Scale of Perceived Social Support and General Self-Efficacy Scale. The associations of social support, self-efficacy and social support × self-efficacy interaction with depressive and anxiety symptoms were examined by hierarchical regression analysis. If the interaction was statistically significant, simple slope analysis was conducted. RESULTS The prevalence of depressive symptoms was 58.2%, while 47.5% RA patients had anxiety symptoms. Social support and social support × self-efficacy interaction were significantly associated with depressive symptoms. Social support, self-efficacy and their interaction were significantly associated with anxiety symptoms. The association between social support and depressive symptoms was gradually reduced in the low (1 standard deviation [SD] below the mean, B=-0.614, β=-0.876, P<0.001), mean (B=-0.395, β=-0.563, P<0.001) and high (1 SD above the mean, B=-0.176, β=-0.251, P=0.002) groups of self-efficacy. For anxiety symptoms, the association was also gradually reduced in the low (B=-0.527, β=-0.774, P<0.001), mean (B=-0.288, β=-423, P<0.001) and high (B=-0.049, β=-0.071, P=0.447) groups of self-efficacy. CONCLUSION There was a high prevalence of depressive and anxiety symptoms in Chinese RA patients. Self-efficacy could attenuate the associations of social support with depressive and anxiety symptoms. Adequate social support and self-efficacy intervention should be provided to alleviate psychological distress.
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Affiliation(s)
- Li Liu
- Department of Social Medicine, School of Public Health, China Medical University
| | - Neili Xu
- Department of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University
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Soósová MS, Macejová Ž, Zamboriová M, Dimunová L. Anxiety and depression in Slovak patients with rheumatoid arthritis. J Ment Health 2016; 26:21-27. [PMID: 27809630 DOI: 10.1080/09638237.2016.1244719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is significantly associated with psychiatric morbidity. Mental health conditions are often unrecognized and untreated in primary care. AIMS To assess prevalence of anxiety and depression and their impact on arthritis pain and functional disability in Slovak patients with rheumatoid arthritis. METHODS Anxiety was assessed by the Beck Anxiety Inventory (BAI), depression by the Zung self-rating depression scale (SDS), pain by the visual analog scale (VAS) and functional disability by the health assessment questionnaire - disability index (HAQ-DI) in 142 patients with rheumatoid arthritis. Spearman's rho was calculated to assess relations between variables. Stepwise linear regression analysis was used to assess impact of anxiety and depression on arthritis pain and functional disability. RESULTS High prevalence of anxiety and depression was observed in arthritis patients. Anxiety and depression were significant predictors of arthritis pain and functional disability. Sex, education, marital status, disease duration and comorbidity had no impact on arthritis pain and functional disability. CONCLUSION These findings support the notions that psychological negative affect can influence subjective perception of arthritis pain and disability. The regular screening of anxiety and depression and the psychological approaches can be useful for managing arthritis patients.
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Affiliation(s)
| | - Želmíra Macejová
- b 1st Department of Internal Medicine, Faculty of Medicine , Pavol Jozef Šafárik University in Košice , Košice , Slovakia
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Association between Giardia and arthritis or joint pain in a large health insurance cohort: could it be reactive arthritis? Epidemiol Infect 2016; 145:471-477. [PMID: 27640995 DOI: 10.1017/s0950268816002120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006-2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1·51, 95% confidence interval 1·26-1·80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0-19 years, age 20-64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.
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Abstract
Objective: The principal objective was to examine pain disability (the degree to which chronic pain interferes with daily activities) among older adults with arthritis. Specifically, answers to two research questions were sought: (a) Does psychological distress reliably predict pain disability; and (b) do certain theoretically important host, sociodemographic, and health-related factors reliably predict pain disability? Method: Descriptive, univariate, and multivariate regression analyses were employed to assess key psychosocial, disease, and host factors among the sample ( N =141) of adults with arthritis, aged [UNKNOWN] 50 years old. Results: The resultant regression model accounted for 63.7% (60.0% adjusted) of the variance and was significant at p < .01. Psychological distress, overall health, disease activity, and disease self-efficacy were found to predict pain disability. Discussion: Sample members with greater pain disability experienced heightened psychological distress, poorer perceptions of their overall health, more surgeries, higher unemployment, more intense disease activity, longer disease duration, and lower disease self-efficacy.
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Affiliation(s)
- Nadine T James
- University of Southern Mississippi, and School of Nursing, University of Alabama at Birmingham, NB 310, 1530 3rd Avenue South, Birmingham, AL 35294-1210, USA.
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Witthauer C, Ajdacic-Gross V, Meyer AH, Vollenweider P, Waeber G, Preisig M, Lieb R. Associations of specific phobia and its subtypes with physical diseases: an adult community study. BMC Psychiatry 2016; 16:155. [PMID: 27209067 PMCID: PMC4875678 DOI: 10.1186/s12888-016-0863-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 05/12/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Specific phobia is the most prevalent anxiety disorder in the community and is associated with substantial impairment. Comorbidity with physical diseases is assumed and has important implications for etiology, treatment, or prevention of the comorbid conditions. However, due to methodological issues data are limited and subtypes of specific phobia have not been investigated yet. We examined the association of specific phobia and its subtypes with physical diseases in a representative community sample with physician-diagnosed physical diseases and diagnostic criteria of specific phobia. METHODS Data of the German Mental Health Survey from 4181 subjects aged 18-65 years were used. Specific phobia was diagnosed using M-CIDI/DIA-X interview; physical diseases were assessed through a self-report questionnaire and a medical interview. Logistic regression analyses adjusted for sex were calculated. RESULTS Specific phobia was associated with cardiac diseases, gastrointestinal diseases, respiratory diseases, arthritic conditions, migraine, and thyroid diseases (odds ratios between 1.49 and 2.53). Among the subtypes, different patterns of associations with physical diseases were established. The findings were partially replicated in the Swiss PsyCoLaus Study. CONCLUSIONS Our analyses show that subjects with specific phobia have an increased probability for specific physical diseases. From these analyses etiological mechanisms of specific phobia and physical disease can be deduced. As subtypes differed in their patterns of associations with physical diseases, different etiological mechanisms may play a role. The findings are highly relevant for public health in terms of prevention and therapy of the comorbid conditions.
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Affiliation(s)
- Cornelia Witthauer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland ,ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Andrea Hans Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
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Sexual Function in Females With Rheumatoid Arthritis: Relationship With Physical and Psychosocial States. Arch Rheumatol 2016; 31:239-247. [PMID: 29900971 DOI: 10.5606/archrheumatol.2016.5838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/10/2016] [Indexed: 01/29/2023] Open
Abstract
Objectives This study aims to assess the frequency rates of sexual problems and associated factors in a cohort of married females with rheumatoid arthritis (RA). Patients and methods The study included 200 female RA patients (mean age 44.2±9.1 years; range 18 to 55 years) and 100 age matched healthy control females (mean age 42.5±6.3 years; range 18 to 55 years). Mean duration of RA was 5.8±4.1 years. All participants were assessed by Health Assessment Questionnaire Disability Index, Numerical Rating Pain Scale, Sexual Disability Scale, psychiatric interview, Beck Depression Inventory, and Spielberger's State-Trait Anxiety Inventory. Results Majority of the patients had grade II physical disability (62%), moderate pain (55%), depression (46%), and anxiety (77%). Sexual disability and loss of sexual desire and satisfaction were reported in 4% to 77.8% of patients which varied with age, duration of RA, degree of physical disability, and psychiatric comorbidities. Multiple regression analysis showed that scores of sexual disability and loss of sexual desire and satisfaction were significantly associated with scores of Health Assessment Questionnaire Disability Index (β=0.347; p=0.018; β=0.501; p=0.001) and depression (β=0.304; p=0.043; β=0.550; p=0.001). Conclusion We may conclude that the frequencies of sexual problems in females with RA are high and closely related to physical disability and psychiatric comorbidities.
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Uguz F, Kucuk A, Aydogan S, Arslan S, Kurt HG, Toker A, Sahin M. Is major depression associated with serum levels of tumor necrosis factor-alpha in patients with rheumatoid arthritis? J Psychosom Res 2015; 79:530-2. [PMID: 26493851 DOI: 10.1016/j.jpsychores.2015.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study presents the serum tumor necrosis factor-alpha (TNF-α) levels in rheumatoid arthritis (RA) patients with major depression and without any psychiatric disorder. METHODS The study sample included 61 patients with a diagnosis of RA. Major depression and other psychiatric disorders were screened with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Blood sample for the determination of serum TNF-α level was obtained before the psychiatric interview. RESULTS The prevalence rates of any depressive disorder and any anxiety disorder were 40.3% (n=25) and 22.6% (n=14), respectively. Fifteen (24.2%) patients had major depression alone, whereas 27 (43.5%) patients were not diagnosed with any psychiatric disorder. We could not determine any significant differences between the patients with major depression alone and patients without any psychiatric diagnosis with regard to the serum levels of TNF-α. CONCLUSIONS The existence of major depression in RA patients does not seem to be associated with serum levels of TNF-α.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey.
| | - Adem Kucuk
- Department of Rheumatology, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Semra Aydogan
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Sevket Arslan
- Department of Clinical Immunology and Allergy, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Hatıce Guncu Kurt
- Department of Psychiatry, University of Istanbul Medeniyet, Faculty of Medicine, Istanbul, Turkey
| | - Aysun Toker
- Department of Biochemistry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Muhammed Sahin
- Department of Physical Medicine and Rehabilitation, Uiversity of Necmettin Erbakan, Faculty of Medicine, Konya, Turkey
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Iaquinta M, McCrone S. An Integrative Review of Correlates and Predictors of Depression in Patients with Rheumatoid Arthritis. Arch Psychiatr Nurs 2015; 29:265-78. [PMID: 26397428 DOI: 10.1016/j.apnu.2015.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/12/2015] [Accepted: 04/15/2015] [Indexed: 01/04/2023]
Abstract
Depression creates an additional burden for adults with rheumatoid arthritis (RA), negatively affecting disease outcomes and quality of life. An integrative literature review of twenty-three quantitative studies was conducted on correlates and factors predictive of depression in adults with RA. Methodological assessment tools were used to independently evaluate the data quality by two reviewers. Prevalence rates ranged from 6.6 to 66.25%. Correlates included pain, functional status, disease duration, and RA treatment. Predictors, including sociodemographics, pain, coping ability, support, functional status, and clinical factors, varied depending upon the sample, standardized measure, and geographic location. Understanding correlates/predictors could guide the development of comprehensive care.
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Affiliation(s)
| | - Susan McCrone
- West Virginia University School of Nursing, Morgantown, WV.
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Vermaak V, Briffa NK, Langlands B, Inderjeeth C, McQuade J. Evaluation of a disease specific rheumatoid arthritis self-management education program, a single group repeated measures study. BMC Musculoskelet Disord 2015; 16:214. [PMID: 26289049 PMCID: PMC4546043 DOI: 10.1186/s12891-015-0663-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid Arthritis is a progressive and disabling disease, predicted to increase in prevalence over the next 50 years. Self-management is acknowledged as an integral part in the management of chronic disease. The rheumatoid arthritis specific self-management program delivered by health professionals was developed by Arthritis Western Australia in 2006. The purpose of this study was to determine whether this program would achieve early benefits in health related outcomes, and whether these improvements would be maintained for 12 months. METHODS Individuals with rheumatoid arthritis were referred from rheumatologists. Participants with co-existing inflammatory musculoskeletal conditions were excluded. All participants completed a 6-week program. Assessments occurred at baseline (8 weeks prior to intervention), pre-intervention, post-intervention, and 6 and 12 month follow ups. Outcomes measured included pain and fatigue (numerical rating scale, 0-10), depression and anxiety (hospital anxiety and depression questionnaire), health distress, and quality of life (SF-36 version 2). RESULTS There were significant improvements in mean [SD] fatigue (5.7 [2.4] to 5.1 [2.6]), depression (6.3 [4.3] to 5.6 [3.9]) and SF-36 mental health (44.5 [11.1] to 46.5 [9.5]) immediately following intervention, with long term benefits for depression (6.3 [4.3] to 4.9 [3.9]), and SF-36 subscales mental health (44.5 [11.1] to 47.8 [10.9]), role emotional (41.5 [13.2] to 46.5 [11.8]), role physical (35.0 [11.0] to 40.2 [12.1]) and physical function (34.8 [11.5] to 38.6 [10.7]). CONCLUSION Participants in the program recorded significant improvements in depression and mental health post-intervention, which were maintained to 12 months follow up.
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Affiliation(s)
- Vironique Vermaak
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - N Kathy Briffa
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Bob Langlands
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Charles Inderjeeth
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Jean McQuade
- Arthritis and Osteoporosis Western Australia, Perth, Western Australia, Australia.
- Health, Education & Research Program Manager, Arthritis and Osteoporosis Western Australia, PO Box 34, Wembley WA 6913, 17 Lemnos St, Shenton Park, Western Australia, 6008, Australia.
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Bolu A, Balta S. Psychiatric and cardiovascular comorbidities as causes of long-term work disability among individuals with recent-onset rheumatoid arthritis: comments on the article by Kerola et al. Scand J Rheumatol 2015; 44:523. [DOI: 10.3109/03009742.2015.1008039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miwa Y, Nishimi A, Nishimi S, Saito M, Tokunaga T, Yanai R, Takahashi R, Wakabayashi K, Kasama T, Hosaka M. Combined infliximab and methotrexate treatment improves the depressive state in rheumatoid arthritis patients more effectively than methotrexate alone. Eur J Rheumatol 2014; 1:147-149. [PMID: 27708901 PMCID: PMC5042244 DOI: 10.5152/eurjrheumatol.2014.140074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients have a greater depressive tendency than normal subjects, and infliximab is known to provide quick therapeutic effects and to have high bioavailability for RA. We therefore investigated whether the depressive state of RA patients would be improved by infliximab. MATERIAL AND METHODS The Self-Rating Depression Scale (SDS) was used to evaluate 34 RA patients before and 14 or 30 weeks after inflixi mab treatment using the SDS and Disease Activity Score (DAS) 28. The SDS and DAS28 results before and after treatment were compared. RESULTS We also included 42 cases treated with methotrexate as the control group. The SDS decreased in both groups, and the intraindividual vari ability was p<0.001, indicating that the drugs had significantly different effects on the SDS. The DAS tended to decrease in both groups, but the intraindividual variability was p=0.199, indicating no difference between the two drugs. CONCLUSION This study is a preliminary study, but the data suggest that infliximab may reduce RA disease activity and improve the depressive state.
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Affiliation(s)
- Yusuke Miwa
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Airi Nishimi
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Shinichiro Nishimi
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Mayu Saito
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Takahiro Tokunaga
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Ryo Yanai
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Ryo Takahashi
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | | | - Tsuyoshi Kasama
- Department of Rheumatology, Showa University Faculty of Medicine, Tokyo, Japan
| | - Michio Hosaka
- Department of Rheumatology, Clini of Katsuyama, Yamanashi, Japan
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A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults. Exp Gerontol 2014; 60:46-56. [PMID: 25245888 DOI: 10.1016/j.exger.2014.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/07/2014] [Accepted: 09/18/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND There has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population. METHODS A total of 10,409 U.S. adults aged 55+ participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2. RESULTS Past-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions. CONCLUSION Results of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.
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Jiang Y, Yang M, Wu H, Song H, Zhan F, Liu S, Gao G, Liu Z, Hu Z, He P, Zhang S, Hu Z, Lin Z, Zhang Y, Li Y, Shen L, Huang A, Liao Z, Cao S, Wei Y, Li L, Li Q, Lv Q, Qi J, Huang J, Li T, Jin O, Pan Y, Gu J. The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol 2014; 34:503-10. [PMID: 24946723 DOI: 10.1007/s10067-014-2688-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a standard instrument regularly used to assess disease activity of patients with ankylosing spondylitis (AS). However, the well-being of a patient is also affected by impairment of function as well as psychological status and other factors. The objective of this study was to evaluate if psychological status, stressful life events, and sleep quality contribute significantly to BASDAI. Six hundred eighty-three AS patients satisfying the Modified New York Criteria for AS were recruited from the rheumatology clinics of seven hospitals in China. Patients with other concomitant disorders were excluded. Participants were requested to complete a set of clinical examinations and the following questionnaires: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index Questionnaire (PSQI), Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and Social Readjustment Rating Scale (SRRS). Spearman correlation analysis showed that BASDAI was highly associated with degree and duration of morning stiffness, overall pain, nocturnal back pain, overall back pain, anxiety, and BASFI (all P < 0.001), but were not associated with education, HAQ-S, and sleep medication in PSQI (P > 0.05). Multiple stepwise regression analysis indicated that overall pain was the maximal statistical contribution in predicting disease activity (standardized coefficient, 0.335). In hierarchic multiple regression analysis, psychological variables added an only additional 2.7% to the overall R(2) beyond that accounted for by demographic and medical variables, resulting in a final R(2) of 53.5%. Although BASDAI is a very good measurement of pain and stiffness and to a certain extent effect of functional impairment in AS, it barely takes into account psychological status, stress life events, and sleep quality These factors should be evaluated by other modalities.
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Affiliation(s)
- Yutong Jiang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
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Anyfanti P, Gavriilaki E, Pyrpasopoulou A, Triantafyllou G, Triantafyllou A, Chatzimichailidou S, Gkaliagkousi E, Aslanidis S, Douma S. Depression, anxiety, and quality of life in a large cohort of patients with rheumatic diseases: common, yet undertreated. Clin Rheumatol 2014; 35:733-9. [PMID: 24859781 DOI: 10.1007/s10067-014-2677-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 12/31/2022]
Abstract
A growing amount of literature has explored mainly the role of depression (and/or anxiety) in patients with rheumatic disorders. We aimed at determining the prevalence of depression, anxiety, and their association with quality of life among patients attending a rheumatology clinic, focusing on data regarding concomitant psychiatric treatment. Depression, anxiety, and quality of life were assessed using the Zung Self-Rating Depression Scale, the Hamilton Anxiety Scale, and the Health Assessment Questionnaire, respectively. Overall, 514 rheumatologic patients were studied. Depression and anxiety were documented in 21.8 and 30.8 % of the population, respectively, and correlated significantly with quality of life. Only 13.4 % of patients with depressive symptoms and 12.1 % of patients with anxiety symptoms were receiving antidepressant or antianxiety medication. Given the wide therapeutic armamentarium available nowadays for the management of depression and anxiety, an increased awareness among physicians dealing with rheumatologic patients is warranted in order to integrate detection and effective treatment of anxiety and depression into the routine clinical practice. Special attention should be paid to female patients, patients with longer disease duration, and/or those with established disability.
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Affiliation(s)
- Panagiota Anyfanti
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece.
| | - Athina Pyrpasopoulou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
| | - Sofia Chatzimichailidou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
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Responsiveness of the EuroQol EQ-5D and Hospital Anxiety and Depression Scale (HADS) in rheumatoid arthritis patients receiving tocilizumab. Clin Rheumatol 2014; 33:1055-60. [PMID: 24752345 DOI: 10.1007/s10067-014-2609-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 02/24/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to assess the responsiveness to change of the quality of life evaluated by the EuroQol Five Dimensions Questionnaire (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) after biological treatment in a population of rheumatoid arthritis patients. A cohort of patients with RA (n = 29) treated with tocilizumab (TCZ) were analyzed in the study. The inclusion criteria were patients aged between 18 and 65 years, fulfilling American College of Rheumatology 1987 criteria for RA. All patients had inadequate response to methotrexate and with no prior biologic exposure. They were evaluated clinically including Disease Activity Score 28 (DAS28), and the European Quality of Life 5 Dimensions (EQ-5D) to measure the quality of life, and HAD assessed the anxiety and depression status at the initiation of treatment with anti-IL 6 receptor antibody agent and after 6 months. Sensitivity to change was quantified by the effect size (ES) before and after the treatment with TCZ. Among 29 patients with RA included in the study, 25 were females and 4 males. The mean age was 42 years ± 13.4 (SD). Three patients were excluded from the study before 24 weeks because of serious side effects, and five have missing data. The study population exhibited significant decreases in all measures of disease activity at 24 weeks. Physical activity expressed by the Health Assessment Questionnaire (HAQ) score increased through the observation period (for all p < 0.001). Sensitivity to change was high for the VAS and EQ-5D (ES 1.58 and 1.36, respectively) but only moderate for the HAD anxiety component (ES = 0.70) and small for the HAD depression component (ES = 0.4). The EQ-5D and VAS were more responsive than HADS to evaluate the quality of life on patient with RA treated with TCZ.
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Kolahi S, Noshad H, Fakhari A, Khabbazi AR, Hajaliloo M, Ghahremani Nasab L. Mental health status of women with rheumatoid arthritis in iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14250. [PMID: 24719738 PMCID: PMC3965871 DOI: 10.5812/ircmj.14250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/19/2013] [Accepted: 11/02/2013] [Indexed: 11/16/2022]
Abstract
Background: Chronic diseases are usually accompanied by psychological abnormalities. Anxiety and depression occur in a significant number of patients with rheumatoid arthritis (RA). These psychological problems are likely, to be the results of chronic physical symptoms such as pain and disability. Objectives: The aim of this study was the evaluation of mental health in patients with rheumatoid arthritis in Iran. Patients and Methods: One hundred women with definite diagnosis of RA were evaluated in the outpatient clinic of the Tabriz University of Medical Sciences during one year period. Activity of RA disease was determined according to the Disease Activity Score-28 (DAS-28) scaling system and mental health was evaluated using the General Health Questionnaire-28 (GHQ-28). Based on the cut of point score of 22, prevalence of psychological problems was determined and a comparison was made the between two groups (with and without psychological problems). Results: GHQ28 screening test showed that psychological problems were seen in 49% of studied patients. There were significant difference between duration of disease and DAS-28 score between the two groups (P = 0.001 and P = 0.001, respectively). Somatic symptoms were more frequent in patients with psychological problems (P = 0.001). Somatic symptoms in patient with high disease activity was also more frequent than the other group (P = 0.002). There was a significant positive correlation between the scores of DAS-28 and GHQ-28 (r = 0.329, P = 0.001). Conclusions: This study showed that a considerable portion of patients with RA may have mental problems. The probability of these problems increased with more severe and more prolonged disease.
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Affiliation(s)
- Sousan Kolahi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hamid Noshad
- Chronic Kidney Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Hamid Noshad, Chronic Kidney Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9143115927, E-mail:
| | - Ali Fakhari
- Department of Psychiatry, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Ali Reza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mehrzad Hajaliloo
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Leila Ghahremani Nasab
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Assessment of health-related quality of life, anxiety and depression in patients with early rheumatoid arthritis. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2013.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rezaei F, Neshat Doost HT, Molavi H, Abedi MR, Karimifar M. Depression and pain in patients with rheumatoid arthritis: Mediating role of illness perception. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2013.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD. Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors. J Rheumatol 2014; 41:887-96. [DOI: 10.3899/jrheum.130797] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective.(1) To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA) and to identify associated demographic and disease-related factors. (2) To determine whether there is a difference in the prevalence of depression and anxiety between patients with PsA and those with psoriasis without PsA (PsC).Methods.Consecutive patients attending PsA and dermatology clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T tests, ANOVA, and univariate and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and to determine factors associated with depression and anxiety.Results.We assessed 306 patients with PsA and 135 with PsC. There were significantly more men in the PsA group (61.4% vs 48% with PsC) and they were more likely to be unemployed. The prevalence of both anxiety and depression was higher in patients with PsA (36.6% and 22.2%, respectively) compared to those with PsC (24.4% and 9.6%; p = 0.012, 0.002). Depression and/or anxiety were associated with unemployment, female sex, and higher actively inflamed joint count as well as disability, pain, and fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1-unit increase on the fatigue severity scale was associated with an increased risk of depression (OR 1.5).Conclusion.The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.
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Mostafa H, Radwan A. The relationship between disease activity and depression in Egyptian patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2013.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52:2136-48. [PMID: 24003249 PMCID: PMC3828510 DOI: 10.1093/rheumatology/ket169] [Citation(s) in RCA: 528] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective. There is substantial uncertainty regarding the prevalence of depression in RA. We conducted a systematic review aiming to describe the prevalence of depression in RA. Methods. Web of Science, PsycINFO, CINAHL, Embase, Medline and PubMed were searched for cross-sectional studies reporting a prevalence estimate for depression in adult RA patients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Results. A total of 72 studies, including 13 189 patients, were eligible for inclusion in the review. Forty-three methods of defining depression were reported. Meta-analyses revealed the prevalence of major depressive disorder to be 16.8% (95% CI 10%, 24%). According to the PHQ-9, the prevalence of depression was 38.8% (95% CI 34%, 43%), and prevalence levels according to the HADS with thresholds of 8 and 11 were 34.2% (95% CI 25%, 44%) and 14.8% (95% CI 12%, 18%), respectively. The main influence on depression prevalence was the mean age of the sample. Conclusion. Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.
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Affiliation(s)
- Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
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Harris ML, Loxton D, Sibbritt DW, Byles JE. The relative importance of psychosocial factors in arthritis: findings from 10,509 Australian women. J Psychosom Res 2012; 73:251-6. [PMID: 22980528 DOI: 10.1016/j.jpsychores.2012.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the relative importance of psychosocial factors in arthritis diagnosis in an ageing cohort of Australian women. METHODS This study focused on 10,509 women from the 1946-1951 cohort who responded to questions on arthritis in the fifth mailed population-based survey of the Australian Longitudinal Study on Women's Health conducted in 2007. RESULTS Arthritis was characterised by widespread psychosocial concerns, particularly relating to chronic stress and poor mental health. Univariate analyses revealed that in comparison to women without stress, women with moderate/high stress levels had a 2.5-fold increase in reporting arthritis. Experiencing ongoing negative interpersonal life events concerning illness of a family member/close friend and relationship difficulties was also associated with a 1.4-fold increase in the reporting of arthritis. Likewise, significantly reduced levels of optimism and perceived social support were noted (all associations p<.001). Psychiatric diagnosis was also associated with a two-fold increase in having arthritis (p<.001). Following adjustment for behavioural, demographic and health-related characteristics, anxiety was the only psychosocial factor associated with arthritis (OR=1.4, 95% CI=1.2, 1.7; p<.001). CONCLUSION This study examined, epidemiologically, the relative importance of psychosocial factors in arthritis in an ageing cohort of Australian women. The findings from this population-based study indicate that women with arthritis are more likely to report a range of psychosocial-related problems, particularly with regard to chronic stress perception and anxiety. Longitudinal analyses are required to examine the processes by which stress and psychosocial factors may contribute to arthritis risk and poor adaptation in terms of health-related quality of life.
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Affiliation(s)
- Melissa L Harris
- Priority Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
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