Background The depression is with an average of 16% to 38% one of the most prevalent co-morbidities in rheumatoid arthritis (RA) as well as heart diseases or diabetes mellitus. Few studies investigate the clinical relevance of psychiatric disorders in an early disease stage of the RA and as if they may affect future outcomes in chronicity process.
Objectives The aim was to evaluate the prevalence rates of depression and anxiety in an early arthritis (EA) cohort and the distribution across diagnosis groups and gender. Furthermore, we wanted to investigate whether certain disease parameters of an EA show differences between patients (pts) with normal scores versus (vs) pts with high scores in depression and anxiety to construe strategies for everyday practice by gathering such diseases at an early stage.
Methods In a prospective cross-sectional survey, 176 pts with EA answered the Hospital Anxiety and Depression Scale (HADS). The suspicion of an EA was defined by at least one fluid joint and a disease duration from six weeks to maximum 12 months. We compared the standardized clinical routine assessment with disease activity score 28 (and clinical investigation of 68 joints), visual analogue scale (VAS) for pain and disability according the health assessment questionnaire (HAQ) with results of HADS in different diagnostic groups.
Results The mean age of EA cohort was 50.4±16.1 years (♀ 69.3%, mean disease duration: 4.2±3.4 months). Pts assigned to the following groups: “Rheumatic diseases” (RD, n=108) with subgroups “Rheumatoid Arthritis” (RA, n=55) and “Non-rheumatoid arthritis” (NRA, n=53) and “Non-rheumatic diseases” (NRD, n=68). We found a positive global distress in 47.7% of EA pts. The score in RD group was 50.9% vs 42.6% in NRD group. In RA pts it was 49.1% vs 52.8% in NRA pts. The HADS average was as similar in all groups and if compared to gender. We found out that a positive distress score accompanied with significantly higher means of the tender joint count-68 (TJC, p=0.032), the VAS for pain (p<0.000) and HAQ (p<0.000). RA pts with positive distress score showed higher rates in HAQ (p=0.004) and pain-VAS (p=0.001). NRD pts with positive distress scores had also significant higher means of pain-VAS (p=0.033). Only the NRA group didn't show statistically significant differences.
Conclusions There is an extremely high point prevalence, with almost 50%, of anxiety and depression for EA pts. If EA pts had positive HADS, three established standardized EA measurement instruments (HAQ, VAS for pain, TJC68) showed significantly higher average as if they had negative scores. To improve the treat-to-target concepts in clinical practice with a particular focus on comorbidities, further studies are required. The importance of early psychiatric-psychological interventions in the early stages of RA disease is unclear.
Dougados, M., et al., Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis, 2014. 73(1): p. 62–8
Matcham, F., et al., The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford), 2013. 52(12): p. 2136–48.
Disclosure of Interest None declared
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