Factors of depression among patients with rheumatoid arthritis
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Submission date: 2018-03-13
Final revision date: 2018-05-16
Acceptance date: 2018-08-10
Online publication date: 2018-08-31
Publication date: 2018-08-31
Reumatologia 2018;56(4):219–227
The aim of this study was to assess the correlation between symptoms of depression and the course and clinical picture of rheumatoid arthritis (RA).

Material and methods:
120 patients with RA were included in the study: 104 (87%) female patients and 16 (13%) male patients. All studied patients completed the following questionnaires: Beck Depression Inventory (BDI), Ford Insomnia Response to Stress Test (FIRST), Athens Insomnia Scale (AIS) and Health Assessment Questionnaire (HAQ). The serum levels of IL-1b, TNF-, and IL-6 were measured using standard ELISA assays at the time of the first questionnaire assessment.

Symptoms of depression were found in 91 patients (76%), including 79 (87%) women and 12 (13%) men. There were no significant differences between the prevalence of depression in women and men (p = 0.93). Symptoms of depression occurred more often in patients who were professionally inactive, compared with the professionally active patients (p = 0.04). Significant correlations was demonstrated between the value of BDI and the patient’s pain assessed by the visual analogue scale (VAS) value (r = 0.36), the disease activity assessed by the patient and the physician evaluated in millimetres on the VAS scale (r = 0.38 and r = 0.30, respectively), the number of painful and swollen joints (r = 0.22 and r = 0.26, respectively), DAS28 (r = 0.31) as well as the Health Assessment Questionnaire (HAQ) value (r = 0.46). Longer duration of the disease was observed in patients with symptoms of depression (p = 0.02). Also a significant difference in the assessment of BDI between patients treated with biological drugs and those receiving no such treatment was observed (p = 0.042).

Professional inactivity and longer disease duration are important factors influencing symptoms of depression in patients with RA. Higher values of HAQ increase the probability of the occurrence of depression symptoms. The use of biological drugs that reduce the level of proinflammatory cytokines may have a positive effect on reducing the severity of depressive symptoms.

Li G, Han N, Li Z, et al. Identification of transcription regulatory relationships in rheumatoid arthritis and osteoarthritis. Clin Rheumatol 2013; 32: 609-615.
Lisignoli G, Toneguzzi S, Pozzi C, et al. Chemokine expression by subchondral bone marrow stromal cells isolated from osteoarthritis (OA) and rheumatoid arthritis (RA) patients. Clin Exp Immunol 1999; 116: 371-378.
Euesden J, Danese A, Lewis CM, Maughan B. A bidirectional relationship between depression and the autoimmune disorders – New perspectives from the National Child Development Study. Hashimoto K (ed.). PLoS ONE 2017; 12: e0173015.
Wium-Andersen MK, Ørsted DD, Nielsen SF, Nordestgaard BG. Elevated C-Reactive Protein Levels, Psychological Distress, and Depression in 73 131 Individuals. JAMA Psychiatry 2013; 70: 176-184.
Liu Y, Ho RC, Mak A. The role of interleukin (IL)-17 in anxiety and depression of patients with rheumatoid arthritis Int.
J Rheum Dis 2012; 15: 183-187.
Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. IJCR 2011; 6: 617-623.
Goldberg D, Lecrubier Y. From and frequency of mental disorders across centres. In: Mental Illness in General Health Care: An International Study. Üstün TB, Sartorius N (Eds.). Wiley, Chichester 1995.
Wojnar M, Dróżdż W, Araszkiewicz A, et al. Badania rozpowszechnienia zaburzeń depresyjnych wśród pacjentów zgłaszających się do lekarzy rodzinnych. Psychiatr Prakt Ogólnolek 2002; 3: 187-198.
Veerman JL, Dowrick C, Ayuso-Mateos L, et al. Population prevalence of depression and mean Beck Depression Inventory score. Br J Psych 2009; 195: 516-519.
Rathbun AM, Reed GW, Harrold LR. The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistent and response: a systemic review. Rheumatology (Oxford) 2013; 52: 1785-1794.
McDonough E, Ayearst R, Eder L, et al. Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors.
J Rheumatol 2014; 41: 887-896.
Meesters JJL, Bremander A, Bergman S, et al. The risk for depression in patients with ankylosing spondylitis: a population-based cohort study. Arthritis Res Ther 2014; 16: 418-423.
Palagini L, Mosca M, Tani C, et al. Depression and systemic lupus erythematosus: a systemic review. Lupus 2013; 22: 409-416.
Axford J, Butt A, Heron C, et al. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol 2010; 29: 1277-1283.
Westhovens R, Van der Elst K, Matthys A, et al. Sleep problems in patients with rheumatoid arthritis. J Rheumatol 2014; 41: 31-40.
Alesci S, Martinez PE, Kelkar S, et al. Major depression is associated with significant diurnal elevations in plasma interleukin-6 levels, a shift of its circadian rhythm, and loss of physiological complexity in its secretion: clinical implications. J Clin Endocrinol Metab 2005; 90: 2522-2530.
Hestad KA, Tønseth S, Støen CD, et al. Raised plasma levels of tumor necrosis factor alpha in patients with depression: normalization during electroconvulsive therapy. J ECT 2003; 19: 183-188.
Beurel E, Lowell JA. Th17 cells in depression. Brain Behav Immun 2018; 69: 28-34.
Haroon E, Daguanno AW, Woolwine BJ, et al. Antidepressant treatment resistance is associated with increased inflammatory markers in patients with major depressive disorder. Psychoneuroendocrinol 2018; 95: 43-49.
Yousefi F, Mansor MB, Juhari RB. The Relationship between Gender, Age, Depression and Academic Achievement. Curr Res Psychol 2010; 6: 61-66.
Nolen-Hoeksema S. Gender Differences in Depression. Curr Dir Psychol Sci 2001; 10: 173-176.
Stansfeld S, Candy B. Psychosocial work environment and mental health – a meta-analytic review. Scand J Work Environ Health 2006; 32: 443-462.
Margaretten M, Barton J, Julian L, et al. Socioeconomic Determinants of Disability and Depression in Patients with Rheumatoid Arthritis. Arthritis Care Res 2011; 63: 240-246.
Jiang W, Davidson JRT. Antidepressant therapy in patients with ischemic heart disease. Am Heart J 2005; 150: 871-881.
Bogner HR, de Vries HF. Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial. Ann Fam Med 2008; 6: 295-301.
Egede LE, Zheng D, Simpson K. Comorbit Depression is Associated With Increased Health Care Use and Expenditures in Individuals With Diabetes. Diabates Care 2002; 25: 464-470.
Scherrer JF, Virgo KS, Zeringue A, et al. Depression Increases Risk of Incident Myocardial Infarction Among Veterans Administration Patients With Rheumatoid Arthritis. Gen Hosp Psychiatry 2009; 31: 353-359.
Hoertel N, Blanco C, Oquendo MA, et al. A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study. J Psychiatr Res 2017; 95: 19-27.
Hamilton S,P A new Lead from genetic studies in depressed siblings: assessing studies of chromosome 3. Am J Psych 2011; 168: 783-789.
Wada K, Yamada N, Sati T, et al. Corticosteroid-induced psychotic and mood disorders:diagnosis definef by DSM-IV and clinical picture. Psychosomatics 2001; 42: 461-466.
Uguz F, Akman C, Kucuksarc S, et al. Anti-tumor necrosis therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis. Psychiatry Clin Neurosci 2009; 63: 50-55.
Bechman K, Sin FE, Ibrahim F, et al. Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial. RMD Open 2018; 4: e000676.
Dhavale HS, Gawande S, Bhagat V, et al. Evaluation of efficacy and tolerability of dothiepin hydrochloride in the management of major depression in patients suffering from rheumatoid arthritis. J Indian Med Assoc 2005; 103: 291-294.
Song H, Fang F, Tomasson G, et al. Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA 2018; 319: 2388-2400.
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