Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that predominantly affects the synovial joints and the periarticular structures, leading to persistent pain, functional deterioration, disability, sleep disturbance, and lower quality of life. Psychiatric disturbances are frequently observed in these patients.
Objectives The aim of this trial was to investigate I) the psychiatric disorders in RA and II) the effect of concurrent psychiatric disorders on pain, fatigue, disease activity, sleep quality and health-related quality of life (HRQOL).
Methods The patients who fulfilled the American College of Rheumatology (ACR) criteria for RA were recruited. All the patients were interviewed by a psychiatrist. The psychiatric disorders were evaluated with the Turkish Structured Clinical Interview for DSM-VI Axis I Disorders (SCID-I). Sociodemographic data, disease activity (DAS 28 score) and disease duration were reported. Pain was evaluated with visual analogue scale (VAS), fatigue with Multidimensional Assessment of Fatigue (MAF), and quality of life with 36-item Short Form Health Survey (SF-36), and sleep quality with Pittsburgh Sleep Quality Index (PSQI).
Results One hundred patients with RA were studied (90% women, mean age 52.02±12.74 years; disease duration 10.29±8.99 years). Forty-six (46.0%) patients were diagnosed with a psychiatric disorder. Adjustment disorder (n=15) and major depressive disorder (n=12) were frequently observed in these patients. When we divided the groups as the RA patients with psychiatric disorders and the RA patients without psychiatric disorders, RA patients with psychiatric disorders had significantly higher pain scores (p=0.035) and fatigue scores (p=0.005). There was no difference between groups regarding disease activity. The scores of all domains of the SF-36 were significantly lower in RA patients with psychiatric disorders (p<0.05 for all). While there was no significant difference between groups regarding sleep duration, usual sleep efficiency and sleeping aid use, significant differences in sleep quality, sleep latency, sleep disturbance, daytime sleepiness and PSQI total score were observed. These scores were higher in RA patients with psychiatric disorders (p<0.05).
Conclusions The rate of psychiatric disorders in RA patients was found to be 46% in the present study. We also determined that concomitant psychiatric disorders in RA patients were associated with significantly lower sleep quality and HRQOL and higher fatigue. Early identification of psychiatric disorders in RA patients and early referral to a multidisciplinary psychiatric team are necessary to improve the quality of life, sleep quality, and to reduce fatigue.
Disclosure of Interest None declared