1
|
Ionescu CE, Popescu CC, Agache M, Dinache G, Codreanu C. Depression in Rheumatoid Arthritis: Prevalence and Effects on Disease Activity. J Clin Med 2024; 13:2058. [PMID: 38610822 PMCID: PMC11012436 DOI: 10.3390/jcm13072058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background:The primary objective of this study was to estimate depression's prevalence in a cohort of rheumatoid arthritis (RA) patients, and the secondary objective was to evaluate the impact of depression on disease activity over time. Methods: We included all patients with RA presenting to our clinic from 2019 to 2020, who had three follow-up visits available. Depression prevalence was calculated using the patient's history of diagnosed depression, and disease activity was assessed using the disease activity score for 28 joints (DAS28) and its components: tender joint count (TJC), swollen joint count (SJC), pain value on a visual analog scale (VAS), and inflammatory markers. Results: A total of 400 RA patients were included, 75 of whom had diagnosed depression, generating a prevalence of 18.8%. The mean values of DAS28 and its components were higher, with statistical significance, in the depression subgroup at all three follow-ups (p < 0.001). Conclusions: Depression is prevalent in the RA population, and leads to higher disease activity in dynamic evaluations. Assessing depression could be a psychological marker for RA prognosis with an important outcome in controlling disease activity.
Collapse
Affiliation(s)
- Cătălina-Elena Ionescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu Costinel Popescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Mihaela Agache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Georgiana Dinache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Cătălin Codreanu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| |
Collapse
|
2
|
Zheng Y, Hou Z, Ma S, Huang Z, Peng J, Huang S, Guo R, Huang J, Lin Z, Zhuang Z, Yin J, Xie L. Altered dynamic functional network connectivity in rheumatoid arthritis associated with peripheral inflammation and neuropsychiatric disorders. RMD Open 2024; 10:e003684. [PMID: 38428977 PMCID: PMC10910624 DOI: 10.1136/rmdopen-2023-003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This study explored the dynamic functional connective (DFC) alterations in patients with rheumatoid arthritis (RA) and investigated the correlation between the neuropsychiatric symptoms, peripheral inflammation and DFC alterations. METHOD Using resting-state functional MRI, we investigated the DFC based on spatial independent component analysis and sliding window method for 30 patients with RA and 30 healthy controls (HCs). The Spearman correlation was calculated between aberrant DFC alterations, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HAD), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Diagnostic efficacy of indicators was assessed using receiver operating characteristic analysis (ROC). RESULTS Three dynamic functional states were identified. Compared with HC, patients with RA showed reduced FC variabilities between sensorimotor network (SMN) and insula, SMN and orbitofrontal cortex, which were the crucial regions of sensory processing network. The above FC variabilities were correlated with the MoCA, HAD, CRP and ESR in patients with RA. Additionally, the CRP and ESR were negatively correlated to MoCA and positively related to HAD in patients with RA. The ROC analysis results showed that MoCA, HAD and FC variabilities of the sensory processing network could distinguish patients with RA from HC and also identify patients with RA with high ESR. CONCLUSION Our findings demonstrated that abnormal DFC patterns in sensory processing networks in patients with RA were closely associated with peripheral inflammation and neuropsychiatric symptoms. This indicates that the dynamic temporal characteristics of the brain functional network may be potential neuroimaging biomarkers for revealing the pathological mechanism of RA.
Collapse
Affiliation(s)
- Yanmin Zheng
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiduo Hou
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zikai Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jianhua Peng
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuxin Huang
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ruiwei Guo
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jinzhuang Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhirong Lin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zelin Zhuang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jingjing Yin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lei Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| |
Collapse
|
3
|
Zhang L, Zhu W, Wu B. Network analysis of depression and anxiety symptoms in Chinese rheumatoid arthritis patients. PeerJ 2023; 11:e16356. [PMID: 37953775 PMCID: PMC10634336 DOI: 10.7717/peerj.16356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Rheumatoid arthritis (RA) patients are susceptible to comorbid anxiety and depression. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. The objective of this study was to assess the network structure of depression and anxiety symptoms in Chinese RA patients and identify the central and bridge symptoms as well as how depression and anxiety symptoms are related to quality of life (QoL) in the network. Methods A total of 402 Chinese RA patients were included in this study. Depression and anxiety symptoms were measured by the Hospital Anxiety and Depression Scale (HADS). R software was used to estimate the network. Specifically, we computed the predictability, expected influence (EI) and bridge expected influence (BEI) for each symptom and showed a flow network of "QoL". Results Our network revealed that the strongest edge was D2 "See the bad side of things" and D3 "Not feeling cheerful" across the whole network. For centrality indices, D3 "Not feeling cheerful" and D6 "Feeling down" had the highest EI values in the network, while A4 "Trouble relaxing" and D6 "Feeling down" had the highest BEI values of their respective community. As to "QoL", the strongest direct edge related to it was A1 "Nervousness". Conclusions "Feeling down" and "Not feeling cheerful" emerged as the strongest central symptoms, while "Trouble relaxing" and "Feeling down" were bridge symptoms in the anxiety-depression network of RA patients. Intervention on depression and anxiety symptoms in nurses should prioritize these symptoms.
Collapse
Affiliation(s)
- Lijuan Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beiwen Wu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Victoria MSA, Lucio VR, Cristina HD. Patient self-reported instruments for assessing symptoms in rheumatoid arthritis. Rheumatol Int 2023; 43:1781-1790. [PMID: 37322354 DOI: 10.1007/s00296-023-05355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic joint autoimmune disease with a higher prevalence of depressive symptoms due to the burden of the disease. There are several patient-self-depression scales used for the assessment and a wide range of variations in the prevalence of depression could be related to this. No evidence was found that reports the most accurate, sensitive, and specific depression instrument through an extensive review in the literature. To determine the most precise depression instrument to evaluate RA patients. A systematic review search was directed, considering type of study, prevalence of depressive symptoms, usage of validated depression scales, and reported scale performance measurements. The data extraction followed the PRISMA guidelines, and the risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2. From a total of 1958, only 28 articles included in the analysis. The total number of patients analyzed was 6405, with a mean age of 56.53 years, 4474 women (75.22%), and a mean prevalence of depressive symptoms of 27.4%. The most frequent and the best scale used was the CES-D (n = 12), considering all characteristics. The CES-D reported the best psychometric properties, and it was the most frequently used tool.
Collapse
Affiliation(s)
- Meza-Sánchez Ana Victoria
- Radiology Department, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ventura-Ríos Lucio
- División de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Hernández-Díaz Cristina
- Servicio de Reumatología. Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, Del. Gustavo A. Madero, Mexico City, Mexico.
| |
Collapse
|
5
|
Haberman RH, Um S, Catron S, Chen A, Lydon E, Attur M, Neimann AL, Reddy S, Troxel A, Adhikari S, Scher JU. Paradoxical Effects of Depression on Psoriatic Arthritis Outcomes in a Combined Psoriasis-Psoriatic Arthritis Center. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2023; 8:134-140. [PMID: 38188536 PMCID: PMC10768813 DOI: 10.1177/24755303231186405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Backgroud Psoriatic arthritis (PsA) is a chronic, inflammatory arthritis that, when left untreated, can lead to erosions, deformities and decrease in quality of life. PsA is known to be associated with multiple comorbidities, including cardiovascular, metabolic and mental health syndromes, all of which can increase its overall morbidity and mortality. Objective To characterize a cohort of patients with PsA and understand the impact of depression on PsA outcome measures. Methods 527 consecutive patients with PsA were enrolled in an observational, longitudinal registry that followed them prospectively at standard of care visits. Demographics, medical history, medication use, and clinical exam were all recorded. Results Depression was reported in 22.8% of the population, anxiety in 18%, and attention deficit hyperactivity disorder in 4%. Depression was more common in female participants (P < .001). At baseline, individuals with PsA and concomitant depression had similar tender and swollen joint counts and RAPID3 compared to those without depression, and had lower body surface area affected by psoriasis (P = .04). At year one, all patients had improvement in clinical outcomes. However, patients with depression had a significantly higher tender joint count compared to those without depression (P = .001), despite similar swollen joint count and body surface area. Conclusion In patients with depression, there is a discrepancy between improvement in physician assessed measures and patient reported outcomes. These observations underscore the importance of addressing depression and psychological distress as part of PsA treatment outcomes and points towards the need to address residual pain through co-adjuvant approaches.
Collapse
Affiliation(s)
- Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Seungha Um
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Sydney Catron
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Alan Chen
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Eileen Lydon
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Malavikalakshmi Attur
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Soumya Reddy
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
- Colton Center of Autoimmunity, NYU Langone Health, New York, NY, USA
| |
Collapse
|
6
|
Upadhyaya SK, Malgutte DR, Handa R, Gupta S, Kumar A, Budumuru S. Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic. BMJ Open 2023; 13:e069014. [PMID: 37321814 PMCID: PMC10276963 DOI: 10.1136/bmjopen-2022-069014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This study evaluated the prevalence of fibromyalgia (FM), anxiety and depression in patients with rheumatoid arthritis (RA) and their effects on the clinical parameters of RA during the COVID-19 pandemic. DESIGN Cross-sectional, outpatient clinic, observational, non-interventional. SETTING Single-centre, tertiary care, multispecialty, service and research hospital, north-central India. PARTICIPANTS Adult patients with RA, controls. RESULTS This cross-sectional study included 200 patients with RA diagnosed with the American College of Rheumatology/European League Against Rheumatism 2010 (ACR) criteria and 200 controls. FM was diagnosed using the revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in patients with RA were assessed using multiple Disease Activity Scores. The presence of depression and anxiety was determined using the Hospital Anxiety and Depression Scale. FM was present in 31% of patients with RA compared with 4% of controls in our study. Patients with RA with FM were older, predominantly females with longer disease duration, and more likely to be on steroids. Patients with RA with FM had a higher disease activity, and none of our RA with FM patients were in remission. The multivariable analysis found FM to be an independent predictor of the Simplified Disease Activity Index for RA. Patients with RA with FM had worse functional ability and poorer quality of life. The prevalence of anxiety and depression was 12.5% and 30%, significantly higher in RA with FM patients. CONCLUSION During the COVID-19 pandemic, around one-third of our study patients had FM and depression, significantly higher than pre-COVID-19 times. Thus, mental health assessment should be incorporated into the routine management of patients with RA.
Collapse
Affiliation(s)
| | | | - Rohini Handa
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sirinder Gupta
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil Kumar
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | | |
Collapse
|
7
|
Moudi S, Heidari B, Yousefghahari B, Gholami R, Gholinia H, Babaei M. The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis. Reumatologia 2023; 61:86-91. [PMID: 37223374 PMCID: PMC10201383 DOI: 10.5114/reum/154905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. MATERIAL AND METHODS Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. RESULTS Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. CONCLUSIONS These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.
Collapse
Affiliation(s)
- Sousan Moudi
- Health Research Center, Master of Biostatistics and Epidemiology, Babol University of Medical Science, Iran
| | - Behzad Heidari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Behnaz Yousefghahari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Reza Gholami
- Student Research Committee, Babol University of Medical Sciences, Iran
| | - Hemmat Gholinia
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Mansour Babaei
- Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Iran
| |
Collapse
|
8
|
Ionescu CE, Popescu CC, Agache M, Dinache G, Codreanu C. Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1637. [PMID: 36422176 PMCID: PMC9696661 DOI: 10.3390/medicina58111637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 08/08/2023]
Abstract
Depression is one of the most frequent comorbidities in rheumatoid arthritis (RA); it takes an important toll on the quality of life of these patients and also leads to a decrease in life expectancy. The current article is a narrative review on depression in RA, with the objective to emphasize and raise awareness on the high prevalence, pathogenic mechanisms, and effects that depression has on RA patients. In RA, the prevalence of depression has been shown to be 2 to 3 times higher than in the general population, with a meta-analysis reporting that 16.8% of RA patients have a major depressive disorder. Future studies are needed to determine the most accurate self-reported depression questionnaires and their ideal threshold for defining depression as compared to diagnostic interview as gold-standard for patients with RA to allow better comparisons across studies. The pathogenesis of depression remains to be fully understood, but recent specialty literature suggests that immune-mediated processes are involved and that there are similarities between the neural networks recruited in inflammation and those implicated in the pathophysiology of depression. Depression in patients with RA is associated with poor long-term outcomes. Multiple studies have shown that depression in RA is associated with increased pain, fatigue, and physical disability. It alters treatment compliance, causes more comorbidities, and leads to higher mortality, partly through increased suicide risk. Depression in RA also increases health service utilization and healthcare costs directly through hospitalization, but also indirectly through loss of work productivity. Assessing depression could be a significant psychomarker of rheumatological outcome in RA.
Collapse
Affiliation(s)
- Cătălina-Elena Ionescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Claudiu Costinel Popescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Mihaela Agache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Georgiana Dinache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Cătălin Codreanu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| |
Collapse
|
9
|
Manning-Bennett AT, Hopkins AM, Sorich MJ, Proudman SM, Foster DJR, Abuhelwa AY, Wiese MD. The association of depression and anxiety with treatment outcomes in patients with rheumatoid arthritis - a pooled analysis of five randomised controlled trials. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111613. [PMID: 35898566 PMCID: PMC9310212 DOI: 10.1177/1759720x221111613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune condition associated
with an increased risk of developing depression and anxiety. Depression and
anxiety are associated with worse outcomes in RA, but the magnitude of the
effect of each condition on RA outcomes is unclear. It is also unknown how
pharmacological treatment of depression affects RA outcomes. Objective: The primary aim of this study was to investigate the association of comorbid
depression and anxiety with remission in patients with RA. Secondary aims
were to determine the association between comorbid depression and anxiety on
patient-reported outcomes and the relationship between concomitant use of
antidepressants and remission in patients with depression. Design: Data from patients with moderate to severe RA were pooled from five
randomised controlled trials investigating tocilizumab and conventional
synthetic disease-modifying agents. Methods: Remission was defined as a clinical disease activity index (CDAI) of ⩽2.8 and
simple disease activity index (SDAI) of ⩽3.3. The association between the
time to reach remission and depression and anxiety was analysed using Cox
proportional hazard analysis. Results: Individual patient data were available from 5502 subjects, of whom 511 had
depression, 236 had anxiety and 387 were using antidepressants. Depression
was significantly associated with reduced remission [adjusted HR (95% CI):
0.62 (0.48–0.80), p < 0.001 and adjusted HR (95% CI):
0.59 (0.44–0.79), p < 0.001] using CDAI and SDAI,
respectively. Depression was associated with a lower likelihood of achieving
more subjective outcomes (⩽1 physician global assessment, ⩽1 patient global
assessment) and ⩽1 28-swollen joint count, but not ⩽1 28-tender joint count
or C-reactive protein measurement. Treatment with antidepressants did not
improve outcomes for patients with depression. Anxiety was not significantly
associated with RA remission. Conclusion: Comorbid depression, but not anxiety, was associated with less frequent
remission. Concomitant antidepressant use was not associated with
improvements in RA outcomes in patients with depression.
Collapse
Affiliation(s)
- Arkady T Manning-Bennett
- UniSA: Clinical & Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Ashley M Hopkins
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - David J R Foster
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ahmad Y Abuhelwa
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael D Wiese
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
10
|
Isnardi CA, Capelusnik D, Schneeberger EE, Bazzarelli M, Berloco L, Blanco E, Benítez CA, Luján Benavidez F, Scarafia S, Lázaro MA, Pérez Alamino R, Colombres F, Kohan MP, Sosa J, Gonzalez Lucero L, Barbaglia AL, Maldonado Ficco H, Citera G. Depression Is a Major Determinant of Functional Capacity in Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S180-S185. [PMID: 32732521 DOI: 10.1097/rhu.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of depression among rheumatoid arthritis (RA) Argentinean patients and its association with sociodemographic and clinical factors. METHODS We performed a cross-sectional study of consecutive adults with RA. Sociodemographic data, comorbidities, RA disease activity, and current treatment were assessed. The following instruments were used to evaluate quality of life (EQ-5D-3 L [EURO Quality 5-dimension 3 lines], QOL-RA [Quality of Life-Rheumatoid Arthritis]), functional capacity (HAQ-A [Health Assessment Questionnaire-Argentinean version]), and depression (PHQ-9 [Patient Health Questionnaire 9]; scores 5-9: mild, 10-14: moderate, 15-19: moderate-severe, and ≥20: severe depression, a cutoff value ≥10 is diagnostic of major depression). RESULTS Two hundred fifty-eight patients were included, with a median disease duration of 9 years (interquartile range, 3.6-16.7 years). The m PHQ-9 score was 6 (interquartile range, 2-12.3 years). The prevalence of major depression was 33.8%. The frequency of mild, moderate, moderate/severe, and severe depression was 66 (25.6%), 42 (16.3%), 27 (10.5%), and 18 (7%), respectively. Patients with major depression had worse functional capacity (HAQ-A: mean ± SD, 1.6 ± 0.8 vs. 0.7 ± 0.7; p < 0.0001), poorer quality of life (QOL-RA: mean ± SD, 5.4 ± 1.8 vs. 7.3 ± 1.6; p < 0.0001), greater pain (visual analog scale: mean ± SD, 56.2 ± 27.5 mm vs. 33.4 ± 25.7 mm; p < 0.0001), higher disease activity (Disease Activity Score in 28 joints: mean ± SD, 4.3 ± 1.4 vs. 3.3 ± 1.3; p < 0.0001), higher frequency of comorbidities (67% vs. 33%; p = 0.017), and lower frequency of physical activity (22% vs. 35%; p = 0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (odds ratio, 2.1; 95% confidence interval, 1.6-4.3; p < 0.0001) and quality of life (odds ratio, 0.7; 95% confidence interval, 0.5-0.8; p < 0.0001), independently of disease activity. CONCLUSIONS A third of RA patients in this Argentinean cohort had major depression. In those patients, depression was associated with worst functional capacity and quality of life.
Collapse
Affiliation(s)
- Carolina A Isnardi
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Dafne Capelusnik
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Emilce Edith Schneeberger
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Marcela Bazzarelli
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Laura Berloco
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Eliana Blanco
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Cristian A Benítez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Federico Luján Benavidez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | | | - María A Lázaro
- Instituto de Asistencia Reumatológica Integral, Buenos Aires
| | | | | | - María P Kohan
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | - Julia Sosa
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | | | | | | | - Gustavo Citera
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| |
Collapse
|
11
|
Fakra E, Marotte H. Rheumatoid arthritis and depression. Joint Bone Spine 2021; 88:105200. [PMID: 33932572 DOI: 10.1016/j.jbspin.2021.105200] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023]
Abstract
Depression constitutes the most frequent comorbid condition associated with rheumatoid arthritis (RA), with prevalence rates ranging from 14% to 48%. This wide range can be explained by several factors including subtypes of depression considered, instrument of measure (i.e. self-questionnaires versus clinical interview), threshold applied but also the overlap of symptoms between the two conditions. Despite being a frequent comorbid condition in RA, depressive states are repeatedly underdiagnosed and thus, often remain untreated. Consequences are dramatic as conclusive evidence show that depression deleteriously impacts just about all outcomes of RA, including disease activity, arthritis-related complications, level of pain, chance of remission, quality of life and mortality. Importantly, links between depression and RA appear to be bidirectional as if RA patients show increased prevalence of depression. Conversely, patients with depression compared to the general population have higher risk to develop RA. Among the factors explaining this strong association between depression and RA, recent advances have underlined the putative role of models based on the inflammatory hypothesis. Pro-inflammatory cytokines such as tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-18 are involved in RA pathogenesis, but also in depression. Furthermore, the connections between the central nervous system, the peripheral system and the immune system are now better understood. As a consequence of the strong comorbidity and the aggravate prognostic, the management of patient showing this dual diagnosis should be carefully monitor. The common physiopathology also opens the path to utilization of RA treatment in severe depression or treatment-resistant depression.
Collapse
Affiliation(s)
- Eric Fakra
- Psychiatry department, University Hospital of Saint Etienne, Saint Etienne, France; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France
| | - Hubert Marotte
- Rheumatology department, University Hospital of Saint Etienne, Saint Etienne, France; Inserm U1059, Equipe LBTO, Université de Lyon, Saint-Étienne, France.
| |
Collapse
|
12
|
Li X, Hou Y, Meng X, Li G, Xu F, Teng L, Sun F, Li Y. Folate receptor-targeting mesoporous silica-coated gold nanorod nanoparticles for the synergistic photothermal therapy and chemotherapy of rheumatoid arthritis. RSC Adv 2021; 11:3567-3574. [PMID: 35424296 PMCID: PMC8694156 DOI: 10.1039/d0ra08689d] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
The synergy of photothermal therapy (PTT) and chemotherapy is widely regarded as an effective treatment for complex diseases, such as cancer and inflammation. In this paper, we report the synthesis of a nanoscaled drug delivery system, which was composed of a gold nanorod (GNR) as the photothermal agent and a mesoporous silica shell as the methotrexate (MTX) reservoir, named FAGMs. Due to folate modification on the surface, FAGMs targeted specifically activated macrophages in rheumatoid arthritis (RA). Under 808 nm laser irradiation, FAGMs could kill macrophages by reaching sufficient local hyperthermia with excellent efficiency in the photothermal conversion of GNRs. Meanwhile, internal heating caused hydrogen bond fracture; thus, MTX released rapidly from FAGMs for localized synergistic PTT and chemotherapy. The FAGMs had a mean particle size of about 180 nm and a zeta potential of 14.36 mV. The release rate of MTX from FAGMs in vitro increased markedly under 808 nm laser irradiation. In a cellular uptake study, stronger fluorescence signals were observed in activated macrophages when treated with FAGMs, suggesting that folic acid molecules enabled the enhancement of endocytosis into activated macrophages. In rats with adjuvant-induced arthritis, synergistic treatment excellently inhibited the progression of RA. These results demonstrated that FAGMs could be promising for the treatment of RA.
Collapse
Affiliation(s)
- Xiangyu Li
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Yufei Hou
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Xiangxue Meng
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Ge Li
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Fei Xu
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Lesheng Teng
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Fengying Sun
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| | - Youxin Li
- School of Life Sciences, Jilin University 2699 Qianjin Street, Changchun Jilin 130012 China
| |
Collapse
|
13
|
Howren A, Aviña-Zubieta JA, Da Costa D, Puyat JH, Xie H, De Vera MA. Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study. BMJ Open 2020; 10:e041371. [PMID: 33303458 PMCID: PMC7733182 DOI: 10.1136/bmjopen-2020-041371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders. DESIGN A cross-sectional analysis using data from Canadian Community Health Survey-Mental Health (2012). SETTING The survey was administered across Canada's 10 provinces using multistage cluster sampling. PARTICIPANTS The study sample consisted of individuals reporting depression, anxiety or bipolar disorder. STUDY VARIABLES AND ANALYSIS The explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region. RESULTS Among 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support. CONCLUSION Comorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.
Collapse
Affiliation(s)
- Alyssa Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Faculty of Medicine, Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah Da Costa
- Faculty of Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph H Puyat
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Kojima M, Kojima T, Waguri-Nagaya Y, Takahashi N, Asai S, Sobue Y, Nishiume T, Suzuki M, Mitsui H, Kawaguchi Y, Kuroyanagi G, Yasuoka M, Watanabe M, Suzuki S, Arai H. Depression, physical function, and disease activity associated with frailty in patients with rheumatoid arthritis. Mod Rheumatol 2020; 31:979-986. [PMID: 33066713 DOI: 10.1080/14397595.2020.1838402] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the clinical and psychosocial backgrounds of frailty in rheumatoid arthritis (RA) patients. METHODS Patients with RA between 40 and 79 years of age who visited university hospitals in an urban area were recruited. Well-validated self-reported questionnaires were used to evaluate patient physical function (Health Assessment Questionnaire, HAQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), and frailty (Kihon Checklist). A 28-point Disease Activity Score (DAS-28) was calculated to evaluate RA disease activity. RESULTS A total of 375 RA patients, 323 of whom were women, were enrolled (average age: 65.2 ± 9.7 years; average disease duration: 16.6 ± 11.9 years). The prevalence rates of frailty, working-age (40-64 years), young-old (65-74 years), and old-old (≥75 years) patients were 18.5, 28.8, and 36.6%, respectively. Higher age and longer disease duration were associated with frailty. Multivariable logistic regression analysis revealed that HAQ, DAS-28, and BDI-II scores were independently associated with frailty in RA patients. CONCLUSION Frailty is common, even among working-age RA patients. Physical function, disease activity, and depressive symptoms were independently associated with frailty. A multidisciplinary intervention approach, along with adequate pharmacological therapy, may promote successful aging in patients with RA.
Collapse
Affiliation(s)
- Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toshihisa Kojima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Center of Joint Surgery for Rheumatic Diseases and Osteoporosis, Nagoya City East Medical Center, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Mochihito Suzuki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroto Mitsui
- Department of Orthopaedic Surgery, Aichi Medical University, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mikako Yasuoka
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| |
Collapse
|
15
|
DiRenzo DD, Craig ET, Bingham Iii CO, Bartlett SJ. Anxiety impacts rheumatoid arthritis symptoms and health-related quality of life even at low levels. Clin Exp Rheumatol 2020; 38:1176-1181. [PMID: 32141436 PMCID: PMC7483642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We explored the burden of symptoms of anxiety and depression on health-related quality of life (HRQL) in patients with rheumatoid arthritis (RA). METHODS Adults with RA participating in an observational cohort completed PROMIS tests of depression, anxiety, fatigue, physical function (PF), pain interference (PI), sleep disturbance, and participation in social roles and activities at the baseline visit. Clinical measures of disease status were also obtained. We used ANOVA and partial correlation adjusting for the swollen joint count (SJC) to examine associations of anxiety and depression with other aspects of HRQL. Mild and moderate-severe anxiety were defined as T-scores ≥55.4 and ≥ 62.3 and mild and moderate-severe depression was defined as ≥52.5 and ≥58.6 based on previous validated clinical thresholds. Multivariable linear regression (MVR) was used to identify predictors of emotional distress with a subset analysis of those in remission/low disease activity. RESULTS Of 196 RA participants, 18% had mild anxiety, 9% had moderate-severe anxiety, 18% had mild depression, and 14% had moderate-severe depression symptoms. Anxiety and depression scores were associated with significantly worse mean scores across HRQL domains (p <0.05). In MVR, depression (β=0.75, p<0.001), PF (β=0.14, p=0.024) and fatigue (β=0.15, p=0.015) predicted higher anxiety levels, whereas only anxiety predicted higher depression levels (β=0.70, p=<0.001). In subset analysis, PF no longer predicted higher anxiety levels. CONCLUSIONS Emotional distress is common in RA, even when disease is well controlled, with considerable impacts on other aspects of HRQL even at mild levels.
Collapse
Affiliation(s)
| | - Ethan T Craig
- The Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; and Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Susan J Bartlett
- The Johns Hopkins University, Baltimore, MD, USA, and McGill University, Montreal, QC, Canada
| |
Collapse
|
16
|
Desilet LW, England BR, Michaud K, Barton JL, Mikuls TR, Baker JF. Posttraumatic Stress Disorder, Depression, Anxiety, and Persistence of Methotrexate and TNF Inhibitors in Patients with Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:555-564. [PMID: 32921004 PMCID: PMC7571399 DOI: 10.1002/acr2.11175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/26/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the relationship of posttraumatic stress disorder (PTSD) with earlier treatment discontinuation and medication adherence in US veterans with rheumatoid arthritis (RA). METHODS Veterans Affairs (VA) administrative data (2005-2014) were used to define unique dispensing episodes of methotrexate (MTX) and tumor necrosis factor inhibitors (TNFi) for veterans with RA. Diagnosis codes were used to categorize patients into mutually exclusive groups: PTSD (with/without depression/anxiety), depression/anxiety without PTSD, and neither psychiatric diagnosis. Multivariable Cox proportional hazards models were used to evaluate associations between psychiatric diagnoses and time to disease-modifying antirheumatic drug discontinuation (lapse in refill >90 days). Multivariable logistic regression was used to examine associations of diagnoses with medication nonadherence (proportion of days covered <0.8). RESULTS There were 15 081 dispensing episodes of MTX and 8412 dispensing episodes of TNFi. PTSD was independently associated with a greater likelihood of earlier discontinuation of both MTX (hazard ratio [HR] 1.15 [1.10-1.21]) and TNFi (HR 1.20 [1.13-1.28]). Depression/anxiety had a comparable risk of discontinuation for both MTX (HR 1.14 [1.10-1.19]) and TNFi (HR 1.16 [1.10-1.22]). Depression/anxiety, but not PTSD, was associated with higher odds of MTX (odds ratio [OR] 1.12 [1.03-1.22]) and TNFi (OR 1.14 [1.02-1.27]) nonadherence. CONCLUSION Veterans with RA and comorbid PTSD, depression, or anxiety had poor persistence of MTX and TNFi therapies. These results suggest that earlier discontinuation and low adherence to therapy among patients with RA with these psychiatric comorbidities may contribute to worse disease outcomes. Mechanisms by which these comorbidities contribute to lower adherence deserve further investigation and may lead to targeted interventions to improve disease outcomes.
Collapse
Affiliation(s)
- Luke W Desilet
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Kaleb Michaud
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and Forward, The National Databank for Rheumatic Diseases, Wichita, KS
| | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Joshua F Baker
- Corporal Michael C. Crescenz VA Medical Center and University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
17
|
Van der Elst K, Verschueren P, Stouten V, Pazmino S, De Groef A, De Cock D, Joly J, Moons P, Westhovens R. Patient‐Reported Outcome Data From an Early Rheumatoid Arthritis Trial: Opportunities for Broadening the Scope of Treating to Target. Arthritis Care Res (Hoboken) 2019; 71:1566-1575. [DOI: 10.1002/acr.23900] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/02/2019] [Indexed: 11/12/2022]
Affiliation(s)
| | - Patrick Verschueren
- University Hospitals LeuvenKU Leuven, Catholic University of Leuven Leuven Belgium
| | | | - Sofia Pazmino
- KU Leuven, Catholic University of Leuven Leuven Belgium
| | - An De Groef
- KU Leuven, Catholic University of Leuven Leuven Belgium
| | | | - Johan Joly
- University Hospitals Leuven Leuven Belgium
| | - Philip Moons
- Catholic University of Leuven, Leuven, Belgium, University of Gothenburg, Gothenburg, Sweden, and University of Cape Town Cape Town South Africa
| | - René Westhovens
- University Hospitals LeuvenKU Leuven, Catholic University of Leuven Leuven Belgium
| |
Collapse
|
18
|
Examining the cross-sectional and longitudinal effects of anxiety sensitivity on indicators of disease severity among patients with inflammatory arthritis. J Anxiety Disord 2019; 67:102117. [PMID: 31445391 DOI: 10.1016/j.janxdis.2019.102117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression. RECENT FINDINGS Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with RA and on factors such as medication adherence, both of which lead to poorer disease outcomes. Growing evidence also suggests that inflammation is central both to depression and RA and may account for some of the complex interplay between these conditions. SUMMARY Awareness of a bidirectional relationship between depression and RA through a biopsychosocial framework may assist clinicians in maintaining an appropriate index of suspicion about the co-occurrence of these conditions. This review also suggests an important need for integration of rheumatologic and mental health services and generates hypotheses for future research towards a better understanding of both depression and RA.
Collapse
Affiliation(s)
| | - Scott B. Patten
- Department of Community Health Sciences
- Department of Psychiatry
| | - Cheryl Barnabe
- Department of Community Health Sciences
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
20
|
Michelsen B, Kvien TK. Response to: ‘Depression and anxiety associate with less remission after 1 year in rheumatoid arthritis’ by Boer et al. Ann Rheum Dis 2019; 78:e2. [DOI: 10.1136/annrheumdis-2017-212910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/03/2022]
|
21
|
DiRenzo D, Crespo-Bosque M, Gould N, Finan P, Nanavati J, Bingham CO. Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis. Curr Rheumatol Rep 2018; 20:75. [PMID: 30338418 PMCID: PMC6233984 DOI: 10.1007/s11926-018-0787-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To determine the efficacy of mindfulness-based interventions (MBIs) on clinical and patient-reported outcomes in rheumatoid arthritis (RA). RECENT FINDINGS We identified randomized clinical trials from inception through April 2018 from MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, the Cochrane Library, and hand searches. After screening 338 references, we included five trials with one post-hoc analysis that evaluated MBIs and collectively included 399 participants. Outcome instruments were heterogeneous across studies. Three studies evaluated RA clinical outcomes by a rheumatologist; one study found improvements in disease activity. A limited meta-analysis found no statistically significant difference in the levels of DAS28-CRP in the two studies that evaluated this metric (- 0.44 (- 0.99, 0.12); I2 0%). Four studies evaluated heterogeneous psychological outcomes, and all found improvements including depressive symptoms, psychological distress, and self-efficacy. A meta-analysis of pain Visual Analog Scale (VAS) levels post intervention from three included studies was not significantly different between MBI participants and control group (- 0.58 (- 1.26, 0.10); I2 0%) although other studies not included in meta-analysis found improvement. There are few trials evaluating the effect of MBIs on outcomes in patients with RA. Preliminary findings suggest that MBIs may be a useful strategy to improve psychological distress in those with RA.
Collapse
Affiliation(s)
- Dana DiRenzo
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| | - Monica Crespo-Bosque
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Neda Gould
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick Finan
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| |
Collapse
|
22
|
Crotti C, Biggioggero M, Becciolini A, Favalli EG. Sarilumab: patient-reported outcomes in rheumatoid arthritis. PATIENT-RELATED OUTCOME MEASURES 2018; 9:275-284. [PMID: 30154675 PMCID: PMC6108331 DOI: 10.2147/prom.s147286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the last few decades, strategies for the management of rheumatoid arthritis (RA) have been increasingly oriented toward more comprehensive control of the disease, taking into account even RA extra-articular manifestations, comorbidities, and the patient’s perception about the disease. The need for improving the shared decision-making process suggested by European League Against Rheumatism recommendations is leading to an increasing interest in the role of patient-reported outcomes (PROs) beside the usual more objective criteria for defining clinical response based on disease-activity composite indices. Measurement of such PROs as pain or fatigue may be significantly influenced by mood disorders often complicating RA, the pathogenesis of which is deeply interconnected with phlogistic processes mediated by proinflammatory cytokines. IL6 is a pleiotropic mediator involved in neuroendocrine and neuropsychological processes, besides its well known effects on immune, cardiovascular, and metabolic systems. Therefore, there is a growing body of evidence about the efficacy of IL6 blockade in PRO improvement in RA patients. Sarilumab is a monoclonal antibody binding both soluble and membrane-bound IL6Rα, inhibiting the IL6-mediated signaling pathway with favorable efficacy and safety profile. This review analyzes the importance of PROs in strategies for the management of RA and the pathogenic mechanisms linking IL6 with the patient’s perception of the disease. Moreover, the main findings from sarilumab randomized controlled trials are summarized in detail, emphasizing the potential role of this IL6 blocker in the holistic treatment of RA.
Collapse
Affiliation(s)
- Chiara Crotti
- Department of Clinical Sciences and Health Community, University of Milan.,Division of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | | | | | | |
Collapse
|