The relationship between psychological distress and traditional clinical variables: A 2 year prospective study of 216 patients with early rheumatoid arthritis

University of Oslo, Kristiania (historical), Oslo, Norway
British journal of rheumatology 12/1997; 36(12):1304-11. DOI: 10.1093/rheumatology/36.12.1304
Source: PubMed


In this longitudinal study (12 and 24 months follow-up) of 216 patients with early rheumatoid arthritis (RA) (< or = 4 yr duration), we assessed the strength and stability of the relationship between psychological distress and traditional clinical variables examined the ability of these clinical variables to predict changes in mental distress, and explored the directionality between mental distress and the other clinical variables. Study variables were symptoms of anxiety and depression measured by the Arthritis Impact Measurement Scales, tender joint counts, erythrocyte sedimentation rate (ESR), and self-reported pain and disability. Psychological distress showed high levels of stability over time. Pain and disability were the two variables most strongly and consistently related to mental distress. High levels of disability predicted an increase in depression during the next year; otherwise, changes in psychological distress were not predicted by disease-related variables. Attempts at causal modelling of the temporal relationship between mental distress, pain and disability failed to yield consistent results.

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    • "Chronic pain and restriction of physical activity, instability of the disease symptoms and clinical progression , and ability to predict the prognosis increase the prevalence of anxiety in RA cases [30]. In our study we found highly significant increase in depression in patients compared to the control, this is similar to the study of Smedstad et al. [31] and Dickens et al. [32] but another study did not find this difference [33]. Our findings suggest that some of these differences might be due to methodological problems such as lack of the use of strict criteria and appropriate controls. "
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    ABSTRACT: Aim of the work To assess the effect of clinical manifestations, disease activity and medications on health-related quality of life (HRQoL) among patients with early rheumatoid arthritis (RA). Patients and methods Twenty-six early RA patients (mean age 43.31 ± 10.51 years, disease duration: 16.5 ± 5.2 months) diagnosed according to the 2010 RA classification criteria were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department, Sohag University, and 22 age and sex matched healthy persons participated in a case control study. Demographic data were taken from all participants in the study. The 36-item short-form health survey (SF-36) and Hamilton Anxiety Rating Scale (HAM-A) were assessed as measures of HRQoL and psychiatric comorbidity for both patients and controls. Disease activity in RA was assessed using the disease activity score (DAS28). Scoring algorithms were applied to produce the physical and mental component scores (PCS and MCS). Results There was statistically significant difference in the total SF36 score, anxiety and depression scores of HAM-A scale between patients and controls. The PCS showed the highest significant difference (p < 0.0001), followed by SF36 (p = 0.01) and MCS (p = 0.024). There were no significant differences according to the age, gender, occupation or level of education of the patients. Anxiety and depression scores significantly correlated with the bodily pain and DAS28 scores and inversely with the PCS and MCS. The DAS28 strongly negatively correlated with the PCS and MCS. Conclusion Rheumatoid arthritis has a major impact on many areas of an individual’s life and tends to have a profound impact on the health-related quality of life.
    Full-text · Article · Apr 2014 · Egyptian Rheumatologist
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    • "Our results were similar to those reported in other studies [32] [33]. Not surprisingly, pain has been indicated as a mechanism along the causal pathway for depression in those with RA [34] [35] [36]. Furthermore, depression may confound self-reports of pain [37]. "
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    ABSTRACT: Aim of the work To estimate the prevalence of depression and its relationship with disease activity parameters in Egyptian patients with RA. Patients and methods A cross sectional study was conducted on 170 patients with RA. The following values were assessed for each patient: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), swollen and tender joint counts (SJC and TJC), disease activity score 28 (DAS28), health assessment questionnaire score (HAQ), visual analogue scale (VAS) of pain and hospital anxiety and depression scale-depression subscale (HADS-D). Results The prevalence of depression was 15.29% (26 RA patients). In the depressed RA patients, positive significant correlations were found between HADS-D score and age, disease duration, HAQ score, VAS, DAS28 score and CRP. However, no significant correlation was found between HADS-D score and ESR, number of swollen and tender joints. No significant difference (P > 0.05) was found between depressed male and female patients with RA. Conclusion Patients with RA and co-morbid depression have worse health outcomes. RA cases should be monitored for accompanying depression during follow-up. The identification and treatment of depression in RA paramount to the overall management of RA.
    Preview · Article · Oct 2013 · Egyptian Rheumatologist
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    • "It has been reported that, during the course of arthritis, patients can learn to adjust to their condition and its consequences, and are thus able to maintain a normal stress level.43 Other studies have noted substantial intraindividual variation, which may be due to differences in disease-related factors such as joint tenderness, pain, and disability.9–11,44 A previous study reported that a significant relationship exists between arthritis onset and worsening pain, resulting in the development of activity limitation.32 "
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    ABSTRACT: To investigate changes over time in risk factors for the development of Activities of Daily Living (ADL) disabilities in older adults with arthritis. The data were obtained from the Longitudinal Survey of Health and Living Status of the Elderly in Taiwan (1989-1999). The major analytic cohort comprised 977 older adults (458 men and 519 women) with arthritis and without ADL limitation at study baseline. A generalized estimating equations (GEE) model was used to analyze all temporally correlated errors, population-averaged estimates, and longitudinal relationships. Overall, the cumulative incidence of ADL disability in the analytic cohort was 17.4% during an observation period of 11 years. With respect to baseline risk, ADL disability was associated with older age, presence of comorbid chronic conditions, and poor self-rated health. However, the findings changed after accounting for the time-varying nature of risk factors and the temporal sequence of possible cause-and-effect relationships. In addition to the baseline predictors, a high score on the Center for Epidemiologic Studies Depression Scale, lack of regular exercise, and becoming widowed were associated with an increased risk of ADL disability and a decreased chance of recovery. An understanding of the time-varying nature of risk factors for the disabling process is essential for the development of effective interventions that aim to maintain functional ability and prevent limitations among older adults with arthritis.
    Full-text · Article · Nov 2010 · Journal of Epidemiology
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