10-year course of pain and psychological health status in patients with recent onset rheumatoid arthritis

Sigrid degård ^1*, Arnstein Finset ², Petter Mowinckel ¹, Tore K Kvien ¹ and Till Uhlig ¹

¹ Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
² Department of Behavioural Sciences in Medicine, University of Oslo, Norway

^* To whom correspondence should be addressed. E-mail: sigrid.odegard{at}diakonsyk.no.

Accepted 17 March 2007

Abstract

Objective: To examine the course of rheumatoid arthritis (RA) with short disease duration over 10 years, and to identify factors that are associated with the course of pain, depression and anxiety.

Methods: A cohort of 238 RA patients (age 20 to 70 years, mean disease duration 2.3 yrs, 68% RF- positive) was followed with assessments at baseline and after 1, 2, 5 and 10 years. Self-reported health status was assessed by pain on a 100 mm visual analogue scale (VAS), the Arthritis Impact Measurement Scales (AIMS), the 28-item version of General Health Questionnaires (GHQ), and the Health Assessment Questionnaire (HAQ). We also examined erythrocyte sedimentation ratio (ESR), grip strength (kg) and radiographic progression of the hands (van der Heijde modified Sharp score). Repeated measures analyses of variance were used to explore the effect of time on measures of outcome among completers, whereas repeated measures analyses using a mixed model were applied to identify factors that were longitudinally associated with pain, depression and anxiety.

Results: At the various assessment points 30% had VAS pain score >=40mm, 5-13% had AIMS depression score >=4.0 and 20-30% had AIMS anxiety score >=4.0. The perceived level of pain was longitudinally explained by anxiety, disease activity, physical function and female gender, depression by high diseases activity and anxiety, whereas anxiety was explained by low disease activity and depression.

Conclusion: More patients had increased levels of anxiety (20-30%) than increased levels of depression (5- 13%). Several factors, including anxiety, but not depression, were associated with the course of pain.

Keywords: anxiety, depression, longitudinal study, pain, rheumatoid arthritis

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