ABSTRACT: OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in U.S. veterans with rheumatoid arthritis (RA). METHODS: U.S. veterans with RA were enrolled in a longitudinal observational study and were categorized as having 1) PTSD, 2) other anxiety/depression disorders, or 3) neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed effects models were used to examine the associations of diagnostic groups with outcomes measured over a mean follow-up period of 3.0 years. RESULTS: At enrollment, 1,522 patients had a mean age of 63 years, were primarily men (91%), and a majority (78%) reported Caucasian race. A diagnosis of PTSD was observed in 178 (11.7%) and other anxiety/depression diagnoses (excluding PTSD) were found in 360 (23.7%) patients. Presence of a PTSD diagnosis was independently associated with higher values of self-reported pain, physical impairment, tender joint count, and worse patient global well-being scores compared to patients with no psychiatric diagnosis. There were no significant group differences in swollen joint count, erythrocyte sedimentation rate (ESR), or Disease Activity Score (DAS)-28. There were no differences for any outcomes comparing those with PTSD and those with other anxiety/depression diagnoses. CONCLUSION: In this RA cohort, the diagnosis of PTSD was associated with worse patient-reported outcomes and tender joint counts but not with other physician- or laboratory-based measures of disease activity. These results suggest that PTSD, along with other anxiety / depression disorders, may confound RA disease activity assessments that rely on patient-reported outcomes and resulting treatment decisions. © 2012 by the American College of Rheumatology.
Arthritis care & research. 06/2012;