Background In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances.Many researchers have shown that mood disturbance and disability may serve as important pathways through which disease burden contributes to poor health functioning in RA.
Objectives Our aim is to estimate the mood disorders (anxiety and depression) in patients with RA and to evaluate the associated factors.
Methods This is a cross-sectional and descriptive study during a period of the year 2016, including 37 patients followed in the department of Rheumatology in Mahdia Tunisia. All patients were diagnosed with RA based in ACR 1987/EULAR2010.We evaluated for each patient the parameters of activity of the disease, the quality of life by the HAQ questionnaire and the mood disorders using the Hospital Anxiety and Depression Scale (HAD).
Results The age of the RA patients (32 females/5 males) ranged from 21 to 76 years. The mean age was 53.1±12 years. The mean duration of the disease was 11±10 years [1–34]. The mean number of tender joints was 13.2±9.6 and swollen joint was 5.9±7. The mean DAS28 was 5.5±1.5 [2.9–8.2] and HAQ was 1.6±0.9 [0–2.8]. 51.3% of patients had specific joint deformations, 83.8% had radiologic involvement and 29.7% had osteoporosis.
The biologic analysis showed that the mean ESR was 45±27.1 and the CRP was 13.7±25.3. Rheumatoid factors were positive in 37.8% of cases, the ACPA were positive in 32.4% of cases. 81.1% of RA patients were treated by methotrexate and 13.5% were treated by biologic treatments.
The average score of depression was 9±2.6 [1–14]. Basing on this score, 12 patients (32.4% of cases) didn't have depression (score <8), 14 patients (37.8% of cases) suffered probably from depression (score between 8 and 10) and 11 patients (29.7%) had a certain depression (score≥10). Our study didn't found any correlation between the score of depression and the age, the score and clinical parameters of RA (duration of disease, DAS28, number of tender and swollen joints and deformations), the score and biologic parameters (ESR, CRP, Rheumatoid factor, ACPA).
The average score of anxiety was 9.2±4.2 [0–20]. 12 patients (32.4%) didn't have signs of anxiety (score <8), 12 patients (32.4%) had probably an anxiety (score between 8 and 10) and 13 patients (35.2%) presented a certain anxiety (score≥10). We found a significant correlation between the score of anxiety and the number of tender joints, the anxiety score and the HAQ (Health Assessment Quality).
Conclusions Our study showed that the majority of our RA patients suffered from mood disorders; 67.5% had signs of depression and 65.6% had signs of anxiety.So, it's important to evaluate the mood disturbances in RA patients to ameliorate their quality of life.
John A. Sturgeon et al, Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways; reviews Rheumatology 2016.
SARAH R. ORMSETH et al, Multidimensional Model of Disability and Role Functioning in Rheumatoid Arthritis; Arthritis Care & Research, Vol. 67, No. 12, December 2015, pp 1686–1692.
Disclosure of Interest None declared
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