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Meade T, Joyce C, Perich T, Manolios N, Conaghan PG, Katz P. Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:171-180. [PMID: 37779491 DOI: 10.1002/acr.25245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Many studies have reported high rates of anxiety in adults with rheumatoid arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA. METHODS Six databases were searched from January 2000 without restrictions on language/location, study design, or gray literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardized self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesized via a narrative approach. RESULTS Across the 47 studies (n = 11,085 participants), the sample size ranged from 60 to 1,321 participants with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries, and anxiety prevalence ranged from 2.4% to 77%, predominantly determined with standardized self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life. CONCLUSION The reported prevalence of anxiety in RA varied widely potentially because of use of different self-report measures and cutoff points. Such cutoff points will need to be standardized to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.
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Affiliation(s)
- Tanya Meade
- Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline Joyce
- Western Sydney University, Sydney, New South Wales, Australia
| | - Tania Perich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phillip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Tamborena Malheiros R, Escalante Brites G, Gomes Schmitt E, Smolski Dos Santos L, Erminda Schreiner G, Muller de Moura Sarmento S, Gonçalves IL, Duarte da Silva M, Manfredini V. Obesity and its chronic inflammation as pain potentiation factor in rats with osteoarthritis. Cytokine 2023; 169:156284. [PMID: 37418791 DOI: 10.1016/j.cyto.2023.156284] [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: 04/20/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Obesity produces the accumulation of adipose tissue and a chronic inflammatory process, while osteoarthritis (OA) is also an inflammatory disorder. OBJECTIVES to evaluate whether obesity associated to OA may be a factor that increases inflammation and pain. METHODS Male animals (M) were divided into groups: control (CM), OA-induced pain (MP), obese (OM) and obese with OA-induced pain (OMP). Similarly, females (F) were divided into groups: control (CF), OA-induced pain (FP), obese (OF) and obese with OA-induced pain (OFP). All the groups except for control and obese groups were submitted to OA induction by sodium monoiodoacetate injection and monitored until day 65. Their adiposity index, thermal, mechanical and spontaneous pain nociceptive profile were investigated. At the end of the experiment (t = 65 days) hematological parameters, biochemical parameters, andcytokines were assessed. RESULTS Rats with obesity induction showed alterations in mechanical and thermal nociceptive profile, and increase in systemic inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8 and leptin) with reduction in anti-inflammatory cytokines (adiponectin and IL-10). These profile changes were investigated by principal component analysis (PCA), in which the first two principal components explained near 90% of the data variability. Obesity, when present together with OA in OMP and OFP groups, yielded the highest levels of inflammatory cytokines and pain scores and the lowest levels on anti-inflamatory cytokines. CONCLUSION Obesity modified the nociceptive profile when inflammatory process is produced. When obesity occurs concomitantly with OA, inflammatory progression is intensified, yelding increase in pain scores.
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Affiliation(s)
- Rafael Tamborena Malheiros
- Multicenter Graduate Program in Physiological Sciences, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil.
| | - Gabriela Escalante Brites
- Graduate Program in Biochemistry, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Elizandra Gomes Schmitt
- Multicenter Graduate Program in Physiological Sciences, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Laura Smolski Dos Santos
- Graduate Program in Biochemistry, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Genifer Erminda Schreiner
- Graduate Program in Biochemistry, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Silvia Muller de Moura Sarmento
- Multicenter Graduate Program in Physiological Sciences, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Itamar Luís Gonçalves
- Faculty of Medicine, Regional Integrated University of Alto Uruguai and Missões, Sete de Setembro Avenue, 1621, Erechim, Rio Grande do Sul, Brazil
| | - Morgana Duarte da Silva
- Multicenter Graduate Program in Physiological Sciences, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
| | - Vanusa Manfredini
- Multicenter Graduate Program in Physiological Sciences, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil; Graduate Program in Biochemistry, Federal University of Pampa, Campus Uruguaiana, Rio Grande do Sul, Brazil
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Čepukienė V, Puzerienė E. Examining pain severity in women with rheumatoid arthritis: the impact of pain self-efficacy and perceived partner's emotional support. HEALTH PSYCHOLOGY REPORT 2023; 12:14-25. [PMID: 38425891 PMCID: PMC10900974 DOI: 10.5114/hpr/167803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/15/2023] [Accepted: 06/09/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Empirical data suggest that psychosocial factors, such as pain self-efficacy (PSE) and emotional support from a partner, may alleviate the suffering caused by rheumatoid arthritis (RA) pain. However, the data are ambiguous and warrant a more comprehensive investigation into the effect of these factors on the severity of RA pain. The objective of the present study was to assess the significance of PSE and emotional support from a partner in relation to pain severity among women with RA. PARTICIPANTS AND PROCEDURE The study included a sample of 196 women diagnosed with RA with the mean age of 41.54. The study employed the following measures: Rheumatoid Arthritis Pain Scale, Pain Self-efficacy Questionnaire, and Communication Based Emotional Support Scale. RESULTS The analysis revealed that higher PSE emerged as the strongest predictor for lower pain severity across all components of RA pain. However, the impact of the partner's emotional support on pain severity was not as evident and varied depending on the specific pain component. Furthermore, the use of pain medications significantly predicted three out of four pain components. Mediation analysis revealed that perceived emotional support from a partner directly affected women's RA pain intensity, as well as indirectly through the PSE as a mediator. Moderated mediation analysis demonstrated that the association between PSE and pain severity weakened as the duration of RA increased. CONCLUSIONS Enhancing women's PSE and providing appropriate training for their partners to offer effective emotional support may play a crucial role in the treatment of RA.
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Affiliation(s)
| | - Erika Puzerienė
- Department of Psychology, Vytautas Magnus University, Kaunas, Lithuania
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Goudman L, De Smedt A, Moens M. Social Media and Chronic Pain: What Do Patients Discuss? J Pers Med 2022; 12:jpm12050797. [PMID: 35629218 PMCID: PMC9146886 DOI: 10.3390/jpm12050797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
A high number of online support groups have been created on social media platforms to reinforce personal empowerment and social support. The goal of this study was to perform natural language processing by constructing a bag-of-words model and conducting topic modelling based on posts extracted from a chronic pain community. The subreddit called ‘r/sChronicPain’ was used to investigate communication on social media platforms for chronic pain patients. After data cleaning and lemmatisation, a word cloud was constructed, and the most frequent words and most frequent body regions were counted. Latent Dirichlet allocation was used to perform topic modelling. In the final analysis set, 937 unique posts were included. The most frequent word was ‘pain’, followed by ‘doctor’, ‘day’, ‘feel’, ‘back’, ‘year’, and ‘time’. Concerning the body regions, ‘back’ was most often mentioned, followed by ‘neck’ and ‘leg’. Based on coherence scores, one topic was extracted with ‘pain’ as the keyword with the highest weight. In line with the allocation of chronic low-back pain as a major health problem and increasing prevalence, back pain was most often mentioned. It seems that the primarily treatment trajectories that are proposed by medical physicians are discussed on social media, compared to interventions by other healthcare providers.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1900 Brussels, Belgium;
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium;
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-2477-5514
| | - Ann De Smedt
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium;
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1900 Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1900 Brussels, Belgium;
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium;
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1900 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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De Cock D, Doumen M, Vervloesem C, Van Breda A, Bertrand D, Pazmino S, Westhovens R, Verschueren P. Psychological stress in rheumatoid arthritis: a systematic scoping review. Semin Arthritis Rheum 2022; 55:152014. [PMID: 35489168 DOI: 10.1016/j.semarthrit.2022.152014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 04/18/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) considerably impacts patients' mental health. However, it is largely unclear how people suffering from RA experience psychological stress beyond depression or anxiety, and what drives stress in these patients. OBJECTIVE To examine the impact of RA on psychological stress, as follows: 1) How is stress defined and described in studies on RA? 2) Do patients with RA experience more stress than the general population or people suffering from other chronic conditions? 3) What are risk factors for developing stress in this context? METHODS We systematically searched EMBASE, PubMed, Web of Science Core Collection and Cochrane Library for English language peer-reviewed reports published up to 19 April 2020. Eligible studies included any measure or definition of psychological stress as an outcome in patients with RA. Data were extracted on patient and study characteristics, instruments used to measure stress and predictors of stress, and were summarized descriptively. Study quality was assessed with the MINORS or AXIS-tool for longitudinal and cross-sectional studies, respectively. RESULTS Among 11.115 potentially relevant studies, 16 studies were included. Remarkably, 13 different instruments to measure stress were reported in these studies. Different types of stress experienced by patients with RA included role stress, social stress, and work stress. Work stress and social stress, particularly resulting from interpersonal stressors, were reported as more prevalent in patients with RA compared to healthy controls. Stress at disease onset appeared more pronounced in patients with RA compared to people suffering from osteoarthritis, while psychological stress was reported as higher in patients with chronic pain syndromes compared to patients with RA. More disability, more pain, less social support, lower income, younger age and personality traits like excessive worrying, pessimism, and sensitivity to anxiety, seemed to increase the risk for higher stress levels. CONCLUSIONS This scoping review is, to our knowledge, the first to address the important heterogeneity of the measurement tools and definitions of psychological stress in RA research. This review could provide a basis to standardize the concept of stress in people suffering from RA, with a view to proposing tailored stress-reducing interventions.
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Affiliation(s)
- Diederik De Cock
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Michaël Doumen
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
| | | | - Annelies Van Breda
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Sofia Pazmino
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - René Westhovens
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium
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Franke GH, Jagla-Franke M, Küch D, Petrowski K. A New Routine for Analyzing Brief Symptom Inventory Profiles in Chronic Pain Patients to Evaluate Psychological Comorbidity. Front Psychol 2021; 12:692545. [PMID: 34659009 PMCID: PMC8515025 DOI: 10.3389/fpsyg.2021.692545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Question: Comorbidity, i.e., additional psychological distress in patients already suffering from chronic somatic diseases (e.g., orthopedic conditions) is of growing importance. The quality of analyzing and interpreting the often used Brief Symptom Inventory (BSI) used with orthopedic patients should improve by employing a new "case definition" of four groups (instead of two) of differentially psychologically distressed patients instead of two groups as before. Methods: Four groups with the different psychological distress definitions of "no," "mild," "remarkable," and "severe" were to be analyzed from a group of 639 orthopedic patients in inpatient rehabilitation clinics. The BSI is transformed into T values (M=50, SD=10). There is "no" distress if no T [two scales] is ≥60 and "mild" distress if T [two scales] and/or T [GSI] is ≥60 and <63. If T [two scales] and/or T [GSI] is ≥63 and <70, it is "remarkable," and if T [two scales] and/or T [GSI] ≥70, it speaks for "severe" psychological distress. Results: The new tool for analyzing psychological distress based on the T-scores of the BSI resulted in the following four groups: No psychological distress (41.9%): unspecific health-related information stands for a useful intervention. About 13.3% demonstrated low psychological distress: shorter diagnostic interviews and a few more diagnostic examinations led to a low-level outpatient group program to improve health and well-being in a preventive sense; one repeated measurement in 4weeks is advised. Remarkable psychological distress (26%): in-depth exploration using interviews, tests, and questionnaires to choose specific interventions in a single and/or group setting, outpatient or inpatient treatment; repeated measurements and process control. About 18.8% reported severe psychological distress: in-depth exploration led to specific interventions in a single and/or group setting, almost an inpatient setting; immediately crisis intervention and high-frequent process control. Conclusion: The new evaluation strategy of the BSI should improve practice and research; further investigation is necessary.
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Affiliation(s)
- Gabriele Helga Franke
- Division of Psychology of Rehabilitation, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany
| | - Melanie Jagla-Franke
- Division of Psychology of Rehabilitation, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany
| | - Dieter Küch
- Klinik Hochstaufen, Reha-Zentrum Bayerisch Gmain, Bayerisch Gmain, Germany
| | - Katja Petrowski
- Division of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,Department of Internal Medicine III, Dresden University of Technology, Dresden, Germany
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Tong H, Lung Y, Lin SL, Kobayashi KM, Davison KM, Agbeyaka S, Fuller-Thomson E. Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging. Int J Soc Psychiatry 2021; 67:747-760. [PMID: 33176526 DOI: 10.1177/0020764020971003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.
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Affiliation(s)
| | - Yu Lung
- University of Toronto, Toronto, ON, Canada
| | | | | | - Karen M Davison
- Kwantlen Polytechnic University and University of Hawai'I, Surrey, BC, Canada
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Tenorio JDR, Figueiredo MA, Espindula A, Gallottini M, Ortega KL. An interesting case of systemic lupus erythematosus in a patient with Moebius syndrome. SPECIAL CARE IN DENTISTRY 2018; 38:112-115. [PMID: 29356035 DOI: 10.1111/scd.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moebius' syndrome (MS) is characterized by a nonprogressive facial palsy associated with impairment in eye abduction, which can be uni- or bilateral. Some authors raise the possibility that patients with MS may suffer from social stigmatism due to their facial dysmorphism and that constant teasing and bullying perpetrated by people in the same social circle are adjuvants in the development of low self-esteem, behavioral problems, and even psychiatric disorders. Psychological stress, anxiety, and depression are factors contributing to both development and impairment of autoimmune diseases, such as systemic lupus erythematosus (SLE). The objective of this work is to report the case of a patient with MS who developed SLE. In the present case report, we have emphasized the importance of both clinical dental examination and surgeon-dentist in the early diagnosis of systemic diseases by considering that these conditions can affect both syndromic and normoreactive patients.
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Affiliation(s)
| | | | - Aline Espindula
- Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Gallottini
- Department of Oral Pathology, Special Care Dentistry Centre, University of São Paulo, São Paulo, Brazil
| | - Karem López Ortega
- Department of Oral Pathology, Special Care Dentistry Centre, University of São Paulo, São Paulo, Brazil
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