Depression and reactivity to stress in older women with rheumatoid arthritis and osteoarthritis

The Complex Relationship Between Pain, Mental Health, and Quality-of-Life in Patients With Cirrhosis Undergoing Liver Transplant Evaluation

GOALS AND BACKGROUND

Patients with cirrhosis undergoing liver transplant evaluation have high rates of pain and mental health comorbidities; both may significantly impair health-related quality of life (HRQL). We investigated the association between pain, anxiety/depression, and HRQL in this population.

STUDY

In 62 patients with cirrhosis undergoing liver transplant evaluation, we performed 4 validated assessments to characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire). The presence of pain was determined using the BPI-SF screening question. Linear regression was used to identify demographic or clinical factors predictive of pain severity (PS) and interference (PI) and to evaluate the association between pain, anxiety/depression, and HRQL.

RESULTS

Seventy-one percent of patients reported pain, 26% had clinical depression, and 24% had moderate-severe anxiety. Neither liver disease severity, nor its complications were associated with pain (PS or PI), but anxiety and depression were predictors of pain on bivariate analysis. Only depression remained a significant predictor of PS (b=0.28, P<0.05) and PI (b=0.30, P<0.05) in multivariable models. HRQL was inversely associated with PS, PI, depression, and anxiety, but only anxiety (b=-0.14, P=0.003) remained associated with HRQL in the adjusted model.

CONCLUSIONS

Pain is present in over 70% of patients with cirrhosis undergoing liver transplant evaluation. Anxiety and depression were highly correlated with pain and appeared to be key drivers in predicting poor HRQL. Evaluating and managing mental health comorbidities should be explored as a strategy to improve HRQL in patients with cirrhosis and pain.

Analysis of preoperative and postoperative depression and anxiety in patients with osteochondral lesions of the talus

Purpose

This study aims to investigate the psychological status of patients with Hepple V osteochondral lesions of the talus (OLT) and evaluate the effect of autologous osteoperiosteal transplantation (AOPT) on their psychological well-being.

Methods

Fifty patients with Hepple V OLT who underwent AOPT at the Comprehensive Foot and Ankle Surgery Ward of Xi'an Honghui Hospital from November 2021 to May 2023 were included in this study. The patients were divided into two groups based on the presence or absence of preoperative symptoms of anxiety/depression. Group A comprised patients with preoperative symptoms, while Group B included patients without such symptoms. Preoperative and final follow-up assessments included the Hospital Anxiety and Depression Scale for evaluating anxiety and depression, the visual analogue scale for pain assessment, and the American Orthopaedic Foot and Ankle Society scores for assessing ankle and hindfoot function.

Results

Among the 50 Hepple V OLT patients who obtained complete follow-up, twenty-four had preoperative symptoms of anxiety/depression, with an incidence rate of up to 48%. Patients in Groups A and B showed significant improvement in all evaluation indexes after AOPT compared to the preoperative period, but the overall prognosis of Group A was poorer than that of Group B.

Conclusion

AOPT can effectively improve patients' pain, functional activities, and psychological status, and there is a significant correlation between patients' preoperative psychological status and prognosis.

Associations Between Psychological Stress and Hand Pain Among Rural and Urban Adults: Findings From the KoGES Community Cohort Study

Despite known health disparities in chronic pain conditions between rural and urban adults, few studies have examined whether longitudinal associations between psychological stress and hand pain differ. Utilizing community-based cohort data, this study examined whether rural and urban adults differed in the extent to which psychological distress was associated with hand osteoarthritis (OA) symptoms and later functional limitations related to hand pain. Community-dwelling adults (mean age = 51.97, 52.3% women) in a rural (n = 2,971) and urban area (n = 2,782) provided demographic data at baseline and, at a 4-year follow-up, responded to questionnaires about psychological distress and clinical symptoms of hand OA. Levels of functional limitations in hands were assessed at an 8-year follow-up. Ordinal logistic and linear regression were conducted to examine the effects of psychological distress on hand OA symptoms and functional limitations, and whether associations between psychological distress and these pain outcomes were moderated by residential area. The results showed that psychological distress was associated with a higher risk for hand OA symptoms and functional limitations, even after adjusting for demographic and health covariates. There was significant moderation by residential area, such that the association between psychological distress and hand OA was significant only among rural adults and the association with functional limitations was stronger in rural adults than urban adults. Findings suggest greater vulnerability to hand arthritis and hand-related functional limitations among rural adults and the potential for tailored intervention programs to help resolve health disparities among rural communities. PERSPECTIVE: This study compares the association between psychological distress and hand pain outcomes between rural and urban adults using community-based cohort data and suggests that rural adults are more vulnerable to experiencing negative effects of psychological distress on concurrent hand OA symptoms and longitudinal functional limitations in hands.

The mediting role of psychological resilience on the negative effect of pain in patients with rheumatoid arthritis: A cross-sectional study

The objective of this study was to investigate the direct effects of pain-induced depression and anxiety, as well as the mediating role of psychological resilience, on the psychological distress associated with rheumatoid arthritis. The method involved a sample of 196 patients with rheumatoid arthritis and applied the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and visual analog scale for pain. Bivariate and path analyses were performed, and a multiple mediational model was utilized. Results showed that all correlations among study variables were significant (p < 0.01). A partial mediation effect of psychological resilience was observed, and direct effects among the variables (pain, psychological resilience, anxiety, and depression) were statistically significant, including the direct effect of psychological resilience on depression and anxiety. The indirect effects of pain through psychological resilience on depression and anxiety were also significant. Thus, the results suggest that psychological resilience partially mediates the effects of pain-induced anxiety and depression in patients with rheumatoid arthritis.

Patellar malalignment correlates with increased pain and increased synovial stress hormone levels-A cross-sectional study

PURPOSE

Risk factors for the development of pain in the context of knee osteoarthritis (KOA) remain unclear. Radiological findings often do not correlate with clinical findings, so other pathomechanisms in the development and perception of pain must play a role. The purpose of this study is to investigate the correlation of increased sympathetic nervous system (SNS) activity (measured by subjective and objective chronic stress parameters) with KOA severity, patellofemoral malalignment, and pain.

METHODS

47 patients with KOA were assessed. Radiological measurements of tibiofemoral and patellofemoral parameters (Kellgren-Lawrence-score, patellar tilt (PT), Caton-Deschamps-Index and Hepp´s classification) were performed and correlated with knee-specific questionnaires (WOMAC®, KSS©) and chronic stress questionnaires (PSQ-20). Additionally, parameters associated with chronic stress were quantified in synovial fluid and serum samples from patients.

RESULTS

PT correlated significantly with Caton-Deschamps-Index (r = 0.394,p = 0.006) and with medial patellofemoral joint space (r = 0.516,p<0.001). In addition, asymmetric trochlear groove (Hepp's classification > II) was associated with significantly higher PT values (p = 0.014). A negative correlation between PT and KSS©-symptoms subgroup was found (r = -0.340,p = 0.024). Patients with PT<5° had significantly higher scores in the Knee Society Score©-symptoms subgroup (p = 0.038). A positive and significant correlation between synovial aldosterone levels and PT was observed (r = 0.548,p = 0.042).

CONCLUSION

The results of this study indicate that patellar malalignment might correlate with increased pain. The previous specification of standard PT values must be reconsidered as even low PT values seem to play a role in the occurrence of patellofemoral osteoarthritis symptoms. Lower PT values might lead to aggravated symptoms in patients with KOA due to a narrow medial patellofemoral joint space. In addition, PT might induce the release of synovial stress biomarkers and thus contribute to the progression of KOA.

Sleep quality as a mediator of the relation between depression and chronic pain: a systematic review and meta-analysis

BACKGROUND

Chronic pain and depression represent two global health problems with considerable economic consequences. Although existing literature reports on the relation between depression and pain conditions, meta-analytic evidence backing the mediating role of sleep disturbance as one of the main symptoms of depression is scarce. To examine the extent to which sleep disturbance mediates the depression-chronic pain association, we conducted a systematic review and meta-analysis of the associations of chronic pain, depression, and sleep quality.

METHODS

We systematically searched for literature in MEDLINE and other relevant databases and identified cohort and case-control studies on depression, sleep disturbance, and chronic pain. Forty-nine studies were eligible, with a total population of 120 489 individuals. We obtained direct and indirect path coefficients via two-stage meta-analytic structural equation modelling, examined heterogeneity via subgroup analyses, and evaluated primary studies quality.

RESULTS

We found a significant, partial mediation effect of sleep disturbance on the relation between depression and chronic pain. The pooled path coefficient (coef.) of the indirect effect was 0.03 (95% confidence interval [CI]: 0.01-0.05) and accounted for 12.5% of the total effect of depression on chronic pain. This indirect effect also existed for cohort studies (coef. 0.02; 95% CI: 0.002-0.04), European studies (coef. 0.03; 95% CI: 0.004-0.05), and studies that adjusted for confounders (coef. 0.04; 95% CI: 0.01-0.09).

CONCLUSIONS

Sleep disturbance partially mediates the association between depression and pain. Although plausible mechanisms could explain this mediation effect, other explanations, including reverse causation, must be further explored.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO CRD42022338201.

The association between rheumatoid arthritis and reduced estimated cardiorespiratory fitness is mediated by physical symptoms and negative emotions: a cross-sectional study

OBJECTIVES

Persons with rheumatoid arthritis (RA) have lower cardiorespiratory fitness (CRF) than healthy individuals. We sought to identify variables explaining the association between RA status and reduced CRF.

METHODS

RA patients recruited from two Norwegian hospitals and blood donors recruited as controls filled in questionnaires about physical activity, physical symptoms, and psychological factors. Estimated CRF (eCRF) was calculated from non-exercise models. The relationship between RA status and reduced eCRF was explored with structural equation modelling. The latent variables physical symptoms (based on morning stiffness, joint pain, and pain in neck, back, or hips) and negative emotions (based on Hospital Anxiety and Depression Scale's Depression score and Cohen's perceived stress scale) were included as possible mediators between RA status and eCRF in separate and combined models adjusted for age and sex.

RESULTS

Two-hundred-and-twenty-seven RA patients and 300 controls participated. The patients were older and had lower eCRF than controls (age- and sex-adjusted mean difference: 1.7 mL/kg/min, p=0.002). Both latent variables were significant mediators of the association between RA and reduced eCRF when included in separate models. The latent variables mediated 74% of the total effect of RA on eCRF in the combined model. Standardized coefficients: direct effect of RA -0.024 (p=0.46), indirect effect through physical symptoms -0.034 (p=0.051), and indirect effect through negative emotions -0.034 (p=0.039).

CONCLUSION

Both physical symptoms and negative emotions mediated the association between RA and reduced eCRF with similar effect sizes. To successfully increase CRF in RA patients, both physical and psychological factors should be addressed. Key Points • The RA patients in the present study had 1.7 mL/kg/min lower mean estimated cardiorespiratory fitness (CRF) compared to healthy controls. • Mediation analysis demonstrated that physical symptoms and negative emotions mediated 74% of the total negative effect of RA on estimated CRF in a combined, adjusted model. • This suggests that both physical and psychological factors should be addressed when supporting RA patients in improving their CRF.

Check-in Phone Calls Six Weeks and Six Months After Musculoskeletal Specialty Care

Health organizations want to measure patient-reported outcome measures (PROMs) longitudinally. Two medical assistants called people selectively at 6 weeks and routinely at 6 months to obtain PROMs as part of routine musculoskeletal specialty care. Only 47% of patients (123 of 263) were reached by phone at 6 weeks and 41% (246 of 594) at 6 months. Spanish speakers were more likely to answer. Eighty-nine percent of people reached at 6 weeks and 76% reached at 6 months were willing to complete PROMs. Speaking Spanish, older age, and fewer symptoms of depression were associated with completing PROMs when reached by phone at 6 weeks. Women and Spanish-speaking patients were more likely to participate at 6 months. The observation that most people do not participate in longitudinal PROM measurement in a system that devotes notable resources in the setting of musculoskeletal specialty care-with some variation by psychosocial factors-suggests that longitudinal PROM measurement may be infeasible. Future work can explore alternative measures of the value of care that account for the large percentage of people that deprioritize care after a single specialty visit.

Usual presence and intensity of pain are differentially associated with suicidality across chronic pain conditions: A population-based study

OBJECTIVES

This study examined the prevalence of suicidality and associations with pain characteristics (i.e., presence of usual pain/discomfort, pain intensity) among those with chronic pain conditions (i.e., arthritis, migraine, back pain).

METHODS

We analyzed data from the 2012 Canadian Community Health Survey-Mental Health supplement (N = 25,113), including self-reported pain characteristics and suicidality. Weighted cross-tabulations described suicidality prevalence estimates according to pain characteristics among each chronic pain condition. Multiple logistic regressions evaluated associations between the presence of usual pain/discomfort and suicidality across pain conditions. Post-hoc analyses examined pain intensity in significant associations.

RESULTS

Across pain conditions, rates of suicidality were greater in those usually in pain and with more severe pain, compared to mild or moderate pain. After adjustment, usual pain/discomfort was associated with increased odds of suicide ideation (AOR = 1.79, 95% CI [1.19-2.68], p < .05) and attempts (AOR = 2.49, 95% CI [1.25-4.98], p < .05) among those with migraines, and plans (AOR = 1.55, 95% CI [1.04-2.31], p < .05) in those with back pain (reference = absence of usual pain). Usual pain/discomfort was not associated with suicidality in those with arthritis after adjusting for sociodemographics and psychiatric comorbidity. Post-hoc analyses showed that severe pain was associated with elevated odds of suicide ideation (AOR = 2.19, 95% CI [1.07-4.48], p < .05) in migraines and plans (AOR = 3.11, 95% CI [1.42-6.80], p < .01) in back pain (reference = mild pain).

CONCLUSION

Our findings may facilitate a more targeted approach to screening for suicidality among chronic pain populations.

Depressive symptoms are associated with impaired sleep, fatigue, and disease activity in women with rheumatoid arthritis

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.

The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty

BACKGROUND

This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms.

METHODS

Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics.

RESULTS

The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms.

CONCLUSION

The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.

The efficacy of nursing intervention to reduce preoperative anxiety in patients with total knee arthroplasty: A protocol of prospective randomized trial

BACKGROUND

Some patients undergoing the total knee arthroplasty (TKA) have suboptimal postoperative results, and preoperative anxiety may be one of the reasons for these unsatisfactory results. We perform this randomized control study protocol to determine the effectiveness of nursing intervention, on the basis of motivational interview, to decrease the preoperative anxiety in patients receiving TKA.

METHODS

This is a double-blinded, single-center, placebo-controlled and randomized trial, which will be conducted from December 2020 to June 2021. The protocol of this study was approved by the West China Hospital of Sichuan University (W20200803-28). Sixty patients who will undergo TKA are included in our study. Patients are randomly divided into experiential group (with 30 patients) and the control group (with 30 patients). The control group and experimental group receive an informative and separate session via nursing about the operation preparation and operation process. Both the control group and the experimental group are given habitual treatment, but the experimental group need to receive additional motivational interviews. The primary outcomes are the Hospital Anxiety and Depression Scale and the Amsterdam Preoperative Anxiety and Information Scale. Secondary outcome is postoperative pain, which is assessed by visual analogue scale .

RESULTS

Figure 1 will display the comparison of preoperative and postoperative total average anxiety scores in control group and the experimental group.

CONCLUSION

Preoperative psychological distress is familiar in our patients. We hypothesized that nursing intervention may be associated with reduced preoperative anxiety in the patients receiving TKA.

A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjögren’s Syndrome; Impact of the Disease on Quality of Life, Psychological Adjustment, and Use of Coping Strategies

Background

Fibromyalgia, rheumatoid arthritis, spondyloarthritis, and Sjögren’s syndrome are chronic rheumatic diseases with very different clinical characteristics, but which share symptoms such as pain and fatigue. The aim of the study was to examine the impact of the disease on psychological adaptation in fibromyalgia compared with other rheumatic diseases (rheumatoid arthritis, spondyloarthritis, and Sjögren’s syndrome).

Methods

In a multicenter study, 165 women with rheumatic diseases (48 with fibromyalgia, 47 with rheumatoid arthritis, 47 with spondyloarthritis, 23 with Sjögren’s syndrome) completed the General Health Questionnaire–28 (emotional distress), Fatigue Severity Scale (fatigue), Fibromyalgia Impact Questionnaire (impact of the disease), Coping Strategies Questionnaire (coping), and Mini International Neuropsychiatric Interview (comorbidity with DSM IV axis-I disorders). We used the Kruskal-Wallis test, Mann-Whitney U test, and chi2 test to compare comorbid anxiety and depressive disorders and to compare the impact of the disease on patients’ mental well-being and daily life and adjustment (coping strategies).

Results

Anxiety and depressive disorders were more common in fibromyalgia patients; they had higher scores on impact of the disease, physical symptoms, pain, and fatigue than rheumatoid arthritis patients and reported more fatigue than patients with spondyloarthritis. Overall, they used more maladaptive coping strategies (less use of distancing from pain than patients with rheumatoid arthritis and spondyloarthritis, less use of ignoring pain sensations, and more use of catastrophizing than those with rheumatoid arthritis). No differences were found between fibromyalgia and Sjögren’s syndrome on impact and adjustment.

Conclusions

Compared with other rheumatic diseases, fibromyalgia has a greater impact on daily life; patients have more difficulty adjusting to the disease and generally use poorer strategies to cope with pain.

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

Background

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

Methods

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

Results

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

Conclusion

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

The clinically crucial predictors of depression in women with systemic autoimmune diseases

The researchers' aim of this study was to identify and quantify the useful, clinically crucial predictors of depression in Taiwanese women with systemic autoimmune diseases (SADs). We used a cross-sectional method. A total of 241 Taiwanese women with SADs between 21 and 85 years of age participated in the study. Analysis revealed that the strongest predictors of depression in participants were: perceived stress, fatigue, mental health, physical health, chronic-disease-related comorbidities, self-perceived SAD severity, and social support. The model used in the present study explained 70.9% of the variance in the depression.

Sharing Positive Experiences Boosts Resilient Thinking: Everyday Benefits of Social Connection and Positive Emotion in a Community Sample

The influence of shared enjoyment and positive affect (PA) on resilient thinking was examined in 191 middle-aged adults (40-65 years), participating in a study of resilience. Participants completed diaries assessing positive events, shared enjoyment, PA, and resilient cognitions (RC). Multilevel structural equation modeling was utilized to examine when and who engages in RC. Participants reported more RC on days they experienced more positive experiences. This relationship was explained by shared enjoyment and PA. Level-1 proportional reduction of variance (PRV) for shared enjoyment, PA, and RC was 9%, 10%, and 35%, respectively. Individuals reporting more positive experiences trended toward a more resilient mindset; PA accounted for this relationship. Shared enjoyment mediated the relationship between interpersonal events and PA. These findings suggest PA is integral to having a resilient mindset, and shared enjoyment is a potential mechanism that may influence PA. Level-2 PRV for shared enjoyment, PA, and RC was 22%, 21%, and 55%, respectively. RC were associated with less depression and anxiety; and greater well-being, vitality, and physical functioning at follow-up.

Mental Health and Rheumatoid Arthritis: Toward Understanding the Emotional Status of People with Chronic Disease

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.

Depressive mood and low social support are not associated with arthritis development in patients with seropositive arthralgia, although they predict increased musculoskeletal symptoms

Objective

Studies on the role of psychosocial vulnerability in the development of arthritis must be performed early in the disease course to exclude the reverse explanation that arthritis leads to psychological symptoms. Therefore, the objective of this study was to investigate the longitudinal (5-year) association between depressive mood, daily stressors, avoidance coping and social support as predictors, and the development of arthritis and other clinical parameters as outcomes, in persons with seropositive arthralgia at risk of developing rheumatoid arthritis.

Methods

Five-year follow-up data of 231 patients from the Reade seropositive arthralgia cohort were used. Clinical and psychological data were collected using physical examinations and questionnaires. Mixed models and Cox regression analyses were used to assess the 5-year associations between depressive mood, daily stressors, avoidance coping or social support, and the development of arthritis or clinical parameters (tender joint count, Visual Analogue Scale (VAS) pain, VAS morning stiffness and erythrocyte sedimentation rate (ESR)).

Results

Higher scores for depressive mood and lower scores for social support were not associated with the development of arthritis nor with ESR. However, they were longitudinally associated with an increase in pain (p<0.001), morning stiffness (p<0.01) and tender joint count (p<0.001). No consistent associations were found between daily stressors, avoidance coping and the development of arthritis or other clinical parameters.

Conclusion

Although an effect on the development of arthritis could not be demonstrated, a strong longitudinal association was found between high depressive mood, low social support and clinical parameters. In persons with seropositive arthralgia, depressive symptoms and low social support may increase musculoskeletal symptoms.

Is Social Support Always Related to Stress Reduction in Nursing Home Residents? A Study in Leisure Contexts

The current study examined the main and interaction effects of leisure self-determination and two leisure social support types (emotional and instrumental) on stress in nursing home residents. A total of 139 nursing home residents (mean age = 79.4 years) in Taichung City, Taiwan, were recruited. Data were collected using face-to-face surveys, which included measures of leisure self-determination, leisure emotional support, leisure instrumental support, and stress. Data were analyzed using a hierarchical regression analysis. Results indicated that leisure self-determination and leisure emotional support were significantly and negatively correlated with stress, whereas leisure instrumental support was not. Moreover, higher levels of leisure instrumental support decreased the relationship between leisure self-determination and stress reduction. Therefore, enhancing levels of leisure self-determination and leisure emotional support appears to be an effective means of reducing stress in nursing home residents. However, providing excessive leisure instrumental support to nursing home residents should be avoided. [Res Gerontol Nurs. 2018; 11(4):174-180.].

Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain

OBJECTIVE

To estimate the dynamic causal effects of depressive symptoms on osteoarthritis (OA) knee pain.

METHODS

Marginal structural models were used to examine dynamic associations between depressive symptoms and pain over 48 months among older adults (n = 2,287) with radiographic knee OA (Kellgren/Lawrence grade 2 or 3) in the Osteoarthritis Initiative. Depressive symptoms at each annual visit were assessed (threshold ≥16) using the Center for Epidemiologic Studies Depression Scale. OA knee pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, rescaled to range from 0 to 100.

RESULTS

Depressive symptoms at each visit were generally not associated with greater OA knee pain at subsequent time points. Causal mean differences in WOMAC pain score comparing depressed to nondepressed patients ranged from 1.78 (95% confidence interval [95% CI] -0.73, 4.30) to 2.58 (95% CI 0.23, 4.93) within the first and fourth years, and the depressive symptoms by time interaction were not statistically significant (P = 0.94). However, there was a statistically significant dose-response relationship between the persistence of depressive symptoms and OA knee pain severity (P = 0.002). Causal mean differences in WOMAC pain score comparing depressed to nondepressed patients were 0.89 (95% CI -0.17, 1.96) for 1 visit with depressive symptoms, 2.35 (95% CI 0.64, 4.06) for 2 visits with depressive symptoms, and 3.57 (95% CI 0.43, 6.71) for 3 visits with depressive symptoms.

CONCLUSION

The causal effect of depressive symptoms on OA knee pain does not change over time, but pain severity significantly increases with the persistence of depressed mood.

Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis

BACKGROUND AND AIMS

Sex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA).

METHODS

One hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n=120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time.

RESULTS

Sex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes.

CONCLUSIONS

Findings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain.

IMPLICATIONS

The current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain.

Depressive symptoms and structural disease progression in knee osteoarthritis: data from the Osteoarthritis Initiative

Depressive symptoms are associated with increases in pain and functional limitations in knee osteoarthritis (OA). The aim was to determine whether depressive symptoms are also associated with greater structural knee OA progression. Four years of annual radiographic and clinical assessments from the Osteoarthritis Initiative were analyzed. The Center for Epidemiological Studies Depression Scale was used to identify depressive symptoms (threshold = ≥16) at the baseline visit. Propensity scores were used to match participants with and without baseline depressive symptoms on multiple potential confounders. Assessment of radiographic knee OA was based on changes in individual radiographic features, which included osteophyte (OST) grade and joint space narrowing (JSN) grade. Mixed effect models were used to examine structural progression between depressed and non-depressed participants with definitive radiographic knee OA. Depressive symptoms were significantly associated with a higher risk of OST progression (odds ratio [OR] = 1.74; 95% confidence interval [CI]: 1.01, 3.00) and a non-significant lower risk of JSN progression (OR = 0.40; 95% CI: 0.14, 1.15) 1 year after baseline. Conversely, there was a non-significant lower risk of OST progression (OR = 0.71; 95% CI: 0.28, 1.79) and higher risk of JSN progression (OR = 1.89; 95% CI: 0.71, 5.06) from year 3 to year 4 of follow-up. However, the patterns of OST progression and JSN progression were not significantly different between the depressed and non-depressed (P = 0.25 and 0.15, respectively). The findings provide no evidence that depressive symptoms have a detectable effect on changes in radiographic disease severity in knee OA.

State of the Art Review: Osteoarthritis and Therapeutic Exercise

Therapeutic exercise is an invaluable component to a compre hensive treatment program for patients with osteoarthritis. There are several major components to a complete therapeutic exercise program. Compliance with a long-term home exercise program after discharge from a physical therapy program is a very challenging but extremely important issue. Ideally, therapeutic exercise should be provided under the supervision of a physician who is knowledgeable in the use of exercise as a treatment for musculoskeletal conditions. Many practitioners of physical medicine and rehabilitation (physiatrists) can fill this important role for osteoarthritis patients.

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.

Temporal effect of depressive symptoms on the longitudinal evolution of rheumatoid arthritis disease activity

OBJECTIVE

Depression is common in the rheumatoid arthritis (RA) population, yet little is known of its effect on the course of disease activity. The aim of our study was to determine if prevalent and incident depressive symptoms influenced longitudinal changes in RA disease activity.

METHODS

RA patients with and without depressive symptoms were identified using single-item questions from an existing registry sample. Mixed-effects models were used to examine changes in disease activity over 2 years in those with and without prevalent and incident depressive symptoms. Outcome variables included composite disease activity, joint counts, global assessments, pain, function, and acute-phase reactants. Model-based outcome estimations at the index dates and corresponding 1- and 2-year changes were calculated.

RESULTS

Rates of disease activity change were significantly different in patients with a lifetime prevalence of symptomology, but not incident depressive symptoms, when compared to controls. Prior symptoms were associated with slower rates of disease activity decline, evidenced by the estimated 1-year Clinical Disease Activity Index changes: -3.0 (-3.3, -2.6) and -4.0 (-4.3, -3.6) in patients with and without lifetime prevalence, respectively. Analogous results were obtained for most of the other disease activity outcomes; although, there was no temporal effect of prevalent symptoms of depression on swollen joints and acute-phase reactants.

CONCLUSION

Depressive symptoms temporally influence the evolution of RA disease activity, and the magnitude is dependent on the time of symptomatic onset. However, the effect is limited to patient-reported pain, global assessment, and function, as well as physician-reported global assessment and tender joints.

Stress-related clinical pain and mood in women with chronic pain: moderating effects of depression and positive mood induction

BACKGROUND

Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain.

PURPOSE

This study aims to compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery.

METHODS

Women with fibromyalgia and/or osteoarthritis (N = 110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction.

RESULTS

Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression × mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions.

CONCLUSIONS

Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.

Factors associated with pain experience outcome in knee osteoarthritis

OBJECTIVE

Few strategies to improve pain outcome in knee osteoarthritis (OA) exist in part because how best to evaluate pain over the long term is unclear. Our objectives were to determine the frequency of a good pain experience outcome based on previously formulated OA pain stages and test the hypothesis that less depression and pain catastrophizing and greater self-efficacy and social support are each associated with greater likelihood of a good outcome.

METHODS

Study participants, all with knee OA, reported pain stage at baseline and 2 years. Baseline assessments utilized the Geriatric Depression Scale, Pain Catastrophizing Scale, Arthritis Self-Efficacy Scale, and Medical Outcomes Study social support survey. Using pain experience stages, good outcome was defined as persistence in or movement to no pain or stage 1 (predictable pain, known trigger) at 2 years. A multivariable logistic regression model was developed to identify independent predictors of a good outcome.

RESULTS

Of 212 participants, 136 (64%) had a good pain outcome and 76 (36%) a poor pain outcome. In multivariable analysis, higher self-efficacy was associated with a significantly higher likelihood of good outcome (adjusted odds ratio [OR] 1.14 [95% confidence interval (95% CI) 1.04-1.24]); higher pain catastrophizing was associated with a significantly lower likelihood of good outcome (adjusted OR 0.88 [95% CI 0.83-0.94]).

CONCLUSION

This stage-based measure provides a meaningful and interpretable means to assess pain outcome in knee OA. The odds of a good 2-year outcome in knee OA were lower in persons with greater pain catastrophizing and higher in persons with greater self-efficacy. Targeting these factors may help to improve pain outcome in knee OA.

BDNF-trkB-KCC2-GABA pathway may be related to chronic stress-induced hyperalgesia at both the spinal and supraspinal level

Chronic stresses can induce physiological and psychological changes and result in stress-related neuropsychiatry, sometimes they may also contribute to hypersensitivity to pain known as stress-induced hyperalgesia (SIH). Recently it was found that GABAergic disinhibition is closely related to morphine and chronic inflammation pain induced hyperalgesia in the PAG (periaqueductal gray)-RVM (rostral ventromedial medulla) -spinal descending facilitatory system, the changes of potassium-chloride co-transporter 2 (KCC2) function or expression modulated by brain-derived neurotrophic factor (BDNF) are involved in it. Similarly, chronic stress could induce changes of BDNF, KCC2 and a depolarizing shift in the GABA reversal potential (EGABA). Moreover, the descending facilitatory system has been suggested to be related with SIH, but whether it modulates SIH through disinhibition by the downregulation of KCC2 expression and/or transport function remains unknown. We therefore hypothesized that SIH may be owned to disinhibition caused by the activation of BDNF-trkB-KCC2-GABA pathway, which would provide a new understanding for SIH.

Antidepressant use among persons with recent-onset rheumatoid arthritis: a nationwide register-based study in Finland

OBJECTIVES

The aim of this study was to investigate antidepressant use in a nationwide cohort of persons with incident rheumatoid arthritis (RA) in 2000-2007 in Finland.

METHOD

Register data from the Social Insurance Institution of Finland were used to evaluate antidepressant use in ≥ 50-year-old incident RA patients (n = 10,356) and the same-age general population.

RESULTS

Of the RA patients, 10.0% (n = 1034) had used antidepressants during the year preceding RA diagnosis. The cumulative incidence of antidepressant initiations after RA diagnosis was 11.4% [95% confidence interval (CI) 10.0-12.9] for men and 16.2% (95% CI 14.9-17.5) for women at the end of follow-up (mean 4.4 years). Female gender [age-adjusted hazard ratio (HR) 1.39, 95% CI 1.21-1.60] and increasing number of comorbidities (p for linearity < 0.001) predicted antidepressant initiations. In the last follow-up year, antidepressant use was at the same level among men with RA [prevalence rate ratio (PRR) 0.93, 95% CI 0.82-1.06] but lower among women (PRR 0.89, 95% CI 0.83-0.95) when compared to the general population.

CONCLUSIONS

Antidepressant initiations in early RA were associated with female gender and comorbidity. Although depression is stated to be a sizeable problem in RA, the prevalence of antidepressant use did not exceed the population level.

Anxiety, automatic negative thoughts, and unconditional self-acceptance in rheumatoid arthritis: a preliminary study

Objectives. This research was carried out in two stages: the objectives of the first stage were (1) to identify the existing relationships between the level of anxiety, the frequency of automatic negative thoughts, and unconditional self-acceptance and (2) to capture the existing differences regarding these variables between people diagnosed with rheumatoid arthritis and those with no such medical history. Methods. The sample made up of 50 subjects filled out the following three questionnaires: the Hamilton Anxiety Scale, the Automatic Thoughts Questionnaire, and the Unconditional Self-Acceptance Questionnaire. Results. Psychological anxiety is positively correlated with automatic negative thoughts, while unconditional self-acceptance is negatively correlated with both psychological anxiety and somatic anxiety as well as with automatic negative thoughts. All studied variables were significantly different in rheumatoid arthritis as compared to the control population. Conclusions. The results showed the presence to a greater extent of anxiety and automatic negative thoughts, along with reduced unconditional self-acceptance among people with rheumatoid arthritis. Intervention on these variables through support and counseling can lead to reducing anxiety and depression, to altering the coping styles, and, implicitly, to improving the patients' quality of life.

Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study

BACKGROUND

A subset of patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) has suboptimal postoperative results in terms of Patient Reported Outcomes (PROs), and psychological factors could contribute to these suboptimal results.

OBJECTIVES

To examine the prevalence of anxiety and depressive symptoms in patients undergoing primary THA or TKA preoperatively and postoperatively, and the relationship between preoperative anxiety and depressive symptoms on PROs of THA and TKA.

DESIGN

In this prospective study patients were measured preoperatively, and 3 and 12 months postoperatively. Patients filled in the Hospital Anxiety and Depression Scale, Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS) and a satisfaction questionnaire.

RESULTS

Data were obtained from 149 hip and 133 knee patients. The prevalence of anxiety symptoms decreased significantly from 27.9% to 10.8% 12 months postoperatively in hip patients, and from 20.3% to 14.8% in knee patients. Depressive symptoms decreased significantly from 33.6% to 12.1% 12 months postoperatively in hip patients, and from 22.7% to 11.7% in knee patients. In hip and knee patients, preoperative depressive symptoms predicted smaller changes in different HOOS or KOOS subscales and patients were less satisfied 12 months postoperatively.

CONCLUSIONS

Preoperatively, the prevalence of anxiety and depressive symptoms was high. At 3 and 12 months postoperatively, the prevalence of anxiety and depressive symptoms was decreased in both hip and knee patients. However, patients with preoperative anxiety and depressive symptoms had worse PROs 3 and 12 months after THA and TKA and were less satisfied than patients without anxiety or depressive symptoms.

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis

OBJECTIVE

To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis.

DESIGN

Propensity score matched landmark analysis.

SETTING

Ontario, Canada.

PARTICIPANTS

2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011.

MAIN OUTCOME MEASURE

Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment.

RESULTS

The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients).

CONCLUSIONS

Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.

The influence of perceived stress on the onset of arthritis in women: findings from the Australian Longitudinal Study on women's health

BACKGROUND

Psychosocial factors are considered as risk factors for some chronic diseases. A paucity of research exists surrounding the role of perceived stress in arthritis onset.

PURPOSE

Perceived stress as a risk factor for arthritis development was explored in an ageing cohort of Australian women.

METHODS

This study focused on 12,202 women from the 1946-1951 cohort who completed the Australian Longitudinal Study on Women's Health surveys in 2001, 2004 and 2007. Longitudinal associations were modelled, with and without a time lag.

RESULTS

Findings from the multivariate time lag modelling, excluding women with persistent joint pain, revealed that perceived stress predicted the onset of arthritis, with women experiencing minimal and moderate/high stress levels having a 1.7 and 2.4 times greater odds of developing arthritis 3 years later, respectively (p's < 0.001).

CONCLUSION

Chronically perceiving life as stressful is detrimental to future health. The findings provide support for perceived stress to be considered alongside other modifiable risk factors.

Impairment and disability: Renoir's adaptive coping strategies against rheumatoid arthritis

Pierre-Auguste Renoir was one of the most influential painters in art history, but few people know that he suffered from debilitating rheumatoid arthritis. Despite his arthritis, he was able to maintain an incredible level of precision and efficiency with his painting. More importantly, he remained positive and did not let his condition affect his passion for painting or take away from the beauty that he saw in the world around him. Renoir applied a wide variety of coping mechanisms and used his ingenuity to come up with different ways to continue painting even as his arthritis weakened him. Renoir's long battle with rheumatoid arthritis serves as an inspiration to patients who experience the pain and limited mobility associated with this disease, encouraging them to persevere and to develop coping mechanisms that prevent the effects of their impairment from disabling them.

The relative importance of psychosocial factors in arthritis: findings from 10,509 Australian women

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.

Does Functional Disability Mediate the Pain–Depression Relationship in Older Adults With Osteoarthritis? A Longitudinal Study in China

Older adults with osteoarthritis have been found to be impaired in physical functioning and report higher levels of depression. This study examined the relationships between pain, functional disability, and depression to test the activity restriction model in a cohort of 176 older adults in China. This model states that disability is a mediator for the relationship between pain and depression. Other investigators have found that pain and disability were two independent correlates of depression. In both cross-sectional and longitudinal analyses, the authors found that disability is a mediator, using commonly accepted methods (indirect effect 44%, Sobel Z = 4.07, P < .001; 41%, Sobel Z = 3.45, P < .001, respectively). However, this mediation effect was not seen when the outcome was residualized with the baseline value. When the baseline level of depression is residualized, the effect size of the relationship is reduced, requiring larger sample size to test its effect.

The effectiveness of an aquarobic exercise program for patients with osteoarthritis

Aquarobics, a combination of the words aqua and aerobics, is based on the idea that much more energy is consumed during exercise when resisting water rather than air. The aquarobic exercise program is composed of patient education and aquarobic exercise. The program was effective in enhancing self-efficacy, decreasing pain, and improving depression levels, body weight, and blood lipid levels in patients with osteoarthritis. Therefore, this program can be widely used in a community setting for the management of osteoarthritis.

The long-term costs of traumatic stress: intertwined physical and psychological consequences

The gradual emergence of symptoms following exposure to traumatic events has presented a major conceptual challenge to psychiatry. The mechanism that causes the progressive escalation of symptoms with the passage of time leading to delayed onset post-traumatic stress disorder (PTSD) involves the process of sensitization and kindling. The development of traumatic memories at the time of stress exposure represents a major vulnerability through repeated environmental triggering of the increasing dysregulation of an individual's neurobiology. An increasing body of evidence demonstrates how the increased allostatic load associated with PTSD is associated with a significant body of physical morbidity in the form of chronic musculoskeletal pain, hypertension, hyperlipidaemia, obesity and cardiovascular disease. This increasing body of literature suggests that the effects of traumatic stress need to be considered as a major environmental challenge that places individual's physical and psychological health equally at risk. This broader perspective has important implications for developing treatments that address the underlying dysregulation of cortical arousal and neurohormonal abnormalities following exposure to traumatic stress.

The robust association between childhood physical abuse and osteoarthritis in adulthood: findings from a representative community sample

OBJECTIVE

Research suggests a role of early-life trauma in the development of arthritis. This study investigated the relationship between childhood physical abuse and osteoarthritis (OA) while controlling for age, sex, race, and socioeconomic status (SES), in addition to the following types of risk factors for OA: 1) concurrent childhood stressors, 2) adult health behaviors, and 3) depression.

METHODS

Data from the provinces of Manitoba and Saskatchewan were selected from the 2005 Canadian Community Health Survey (n = 13,093). Respondents with missing arthritis data or with arthritis types other than OA were excluded (n = 1,985). Of the 11,108 remaining respondents, 6.9% (n = 854) reported childhood physical abuse by someone close to them, and 10.1% (n = 1,452) reported that they had been diagnosed with OA by a health professional. The regional-level response rate was 84%.

RESULTS

When adjusting for all 3 types of risk factors, a significant association between childhood physical abuse and OA was found (odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.21-2.00). In contrast, when adjusting for age, sex, race, and SES only, the OR was 1.99 (95% CI 1.57-2.52).

CONCLUSION

The association between childhood physical abuse and OA remained significant, even after controlling for many risk factors that may mediate the relationship. Further research is needed to investigate potential pathways through which arthritis develops as a consequence of childhood physical abuse.

Is elevated noradrenaline an aetiological factor in a number of diseases?

1 Here I put forth the hypothesis that noradrenaline (NA), which is a signalling molecule in the brain and sympathetic nervous system (SNS), is an aetiological factor in a number of diseases. 2 In a previous paper (Fitzgerald, Int. J. Cancer, 124, 2009, 257), I examined evidence that elevated NA is a factor in various types of cancer. Here I extend the argument to several other diseases, including diabetes mellitus, open-angle glaucoma, osteoarthritis and rheumatoid arthritis and asthma. 3 The principal hypothesis is that, largely as a result of genetics, elevated noradrenergic tone in the SNS predisposes a large number of individuals to a broad range of diseases. 4 For each of the above five diseases, I briefly examine the following four lines of evidence to assess the hypothesis: i) whether pharmacological studies in rodents that manipulate NA levels or receptors affect these diseases; ii) whether pharmacological manipulation of NA in humans affects these diseases; iii) whether bipolar disorder, excessive body weight, and hypertension, which may all three involve elevated NA, tend to be comorbid with these diseases and iv) whether psychological stressors tend to cause or exacerbate these conditions, since psychological stress is associated with increased release of NA. 5 The four lines of evidence tend to support the hypothesis.

Depression, inflammation, and pain in patients with rheumatoid arthritis

OBJECTIVE

An association between depression and inflammation has been suggested. In patients with rheumatoid arthritis (RA), pain is a major symptom associated with depression and inflammation. We examined the independent associations between depression, the inflammation marker C-reactive protein (CRP) level, and pain in patients with RA.

METHODS

In total, 218 RA outpatients completed self-administered questionnaires, using the Beck Depression Inventory II to measure depressive symptoms and a visual analog scale to quantify their perceived pain. Functional disability and CRP level were also measured.

RESULTS

Depression scores were mildly and positively correlated with the CRP level (r = 0.46, P < 0.001). Both the depression score (standardized beta = 0.35, P < 0.001) and the CRP level (standardized beta = 0.35, P < 0.001) were significantly associated with pain, even after adjustment for clinical covariates in regression analysis. In logistic analysis, the combined effects on the risk of severe pain (pain score in the upper tertile) increased with depression scores and CRP levels linearly.

CONCLUSION

Depression severity and inflammation were associated with each other and appeared to have independent effects on perceived pain. Therefore, a clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control.