Background Depression increases the burden of RA to the patients and to the society.
Objectives To estimate the presence and severity of depression in patients with RA. To determine the interaction of depression with disease activity, the functional disability and the radiographic findings. To analyze the quality of social relatioships in patients with RA.
Methods 124 patients (76.78% female, mean age 53.83±10.13 years, mean disease duration 64.4±30.3 month) who fulfilled the ACR 1987 criteria for RA and 115 age-matched healthy controls (CG) were included in this study. Patients with RA were subdivided in 2 groups: patients with mono therapy with Methotrexate (MTX) and patients on combined therapy with MTX and biological therapy. Out of the total number of examinees, 46% received combined therapy (MTX + biological therapy) and 54% of patients were treated using mono therapy (MTX). Disease activity was determined using DAS 28 SE. The functional status was determined on the basis of the HAQ questionnaire, while the radiographic state was scored with the Larsen method. The intensity of the pain was evaluated by completing of VAS scale (0-100 mm). The degree of depression was determined through application of the Beck scale for depression (Beck Depression Inventory). Assessment of the quality social relationships was performed using questionnaire which contained questions concerning demographical characteristics and social relationships. The statistical analyzes was performed by the data SPSS package, version 15.0.
Results The symptoms of depression were registered in 73.33% of pts, significantly more than in CG (21.34%), p<0.01. Mild depression was registered in 33.33% of pts, moderate in 20%, pronounced in 15.56%, and major depression in 4.4% of pts. DAS28 SE was significantly lower in combined group than in group on mono therapy with MTX (4.22±1.34 respectively 5.6±1.32, p<0.001). The mean value of the Beck index of the pts. receiving biological therapy was significantly lower than the value of the Beck index of the pts. receiving mono therapy (12.8±8.14 vs.15.96±8.20, p<0.05). The relation between the age of patients, the duration of the disease, VAS of pain, radiological stage of the disease, and HAQ index with the Beck index of depression was also studied. The results of the linear regression analysis show that the degree of depression is separately affected by the duration of the disease and the functional status of the patient (coeff. β:0.284 and 0.764). The model of multiple regression analysis emphasizes the functional status as the most important predictor of depression (coeff. β is 0.738), p<0.001. The analysis of the quality of life and social relationships showed that the social support is reduced to the family and spouse and that patients are satisfied with the organization of health care in the region. They do not feel discriminated against in their own surroundings. RA patients do not perceive the possibilities of wider social support, which points to the fact that it is not sufficiently developed in Serbia.
Conclusions Depression is a frequently present manifestation of RA patients which is most prominently influenced by the degree of functional disability of RA patients. Apart from the medication therapy, the treatment of RA requires an individual psychosocial approach and wider social support.
Disclosure of Interest None Declared