Background Counter to the course of physical function and structural damage, few studies have addressed psychological health status as the primary outcomes in rheumatoid arthritis (RA) researches. Depression and its predictors among RA patients appear to be unrecognized or under-treated. In African and Arabic region, there are limited data outlining depression in RA.
Objectives We aimed to determine the prevalence of depression in Moroccan patients with RA and to evaluate the disease-related parameters influencing it.
Methods 250 consecutive patients with RA were recruited. Patients with previous psychological disorders and significant comorbidities were excluded. The Patient Health Questionnaire depression scale (PHQ-9) was used to measure depressive symptoms. For all patients were collected: socio-demographic characteristics; disease duration; joint pain intensity (visual analogue scale); disease activity (measured clinically using physical examination, biologically and by the disease activity scores (DAS28)); structural damage (by radiographs scored using the Sharp’s method as modified by Van der Heijde); functional disability (by the Health Assessment Questionnaire (HAQ)); extra-articular manifestations; immunological status and treatments. Fatigue was assessed on a 0-100 visual analogue scale (VAS fatigue) and the Arabic version of the generic instrument SF-36 was applied to assess quality of life (QoL).
Results There was high prevalence of depressive syndrome among or RA patients: 164 (65.6%) patients have major depressive syndrome and 64 (25.6%) have minor depressive syndrome with a mean total score of PHQ-9 =17.3±8.1indicating a moderate-severe depression. Severe depressive syndrome and higher scores of PHQ-9 were associated with female gender, disease duration, pain intensity, clinical and biological disease activity (DAS28, ESR and CRP), functional disability, structural damage, high levels of RF and ACPAs, higher VAS fatigue scores and impaired physical and mental domains of QoL (for all p≤0.01). Also, patients with decreased levels of education and low socioeconomic status had significantly higher scores of depression (for all p<0.001). In multiple regression analysis the main factors associated to depression were: pain intensity (R2=0.525; p=0.001); disease activity (DAS28 (R2=0.495; p=0.003) and CRP (R2=0.658; p<0.001)); functional disability (R2=0.448; p=0.005); ACPAs levels (R2=0.319; p=0.015) and Sharp score (R2=0.377; p=0.012).
Conclusions Depression is a major issue among our RA which influenced negatively different aspects of QoL. In our data, depression was associated with low socioeconomic and educational status, pain intensity, disease activity, fatigue, functional disability, ACPAs and structural damage. Depression must be recognized and included in the assessment and management of our patients. The advent of new treatments may improve depressive symptoms through their action on inflammation, pain, fatigue and physical disability.
Disclosure of Interest None Declared