Depression in RA Patients May Be Higher Than Previously Reported

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Rheumatoid arthritis patients scored high for both depression and anxiety

January 23, 2014 / Author:  / Reviewed by: Joseph V. Madia, MD Robert Carlson, M.D Beth Bolt, RPh

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(dailyRx News) People with severe rheumatoid arthritis (RA) can be depressed about their health situation and anxious about what lies ahead. A new study looked at just how many people with RA were depressed.

The number of people with RA who were depressed was higher than previously thought, this new study found.

Because of these findings, the study's researchers believe that people living with RA should routinely be screened for depression.

"If you’ve lost energy to pursue your interests, talk to your doctor."

This study, led by Anne Barton, PhD, FRCP, a researcher at the Arthritis Research UK Centre for Genetics and Genomics at the University of Manchester in the UK, sought to learn how psychological factors impact each of the different parts of the measure of RA activity called the DAS28.

Rheumatoid arthritis is a serious condition in which inflammation affecting the joints and body's internal organs leads to ongoing (chronic) pain and fatigue.

"Chronic pain and fatigue, especially in severe situations, will often contribute to a depletion of basic functioning skills (sleeping and eating within the normative range) for an individual, which is the foundation for mental wellness for any person," said Daniel Berarducci, MA, a Clinical Professional Counselor at Person-Holistic Innovations in Las Vegas, Nevada.

"After prolonged exposure to such chronic pain and fatigue for an individual who may be experiencing a significant medical condition, such as rheumatoid arthritis, these combined effects of pain, fatigue, and potentially a lack of sleep and healthy nutrition will not allow the body to engage in its fullest potential of restorative/regenerative healing that the body needs on a daily basis," Berarducci told dailyRx News.

"Thereafter, through the mind-to-muscle connections of the body, one will potentially become prone to or more susceptible to mental health concerns (depression and anxiety) through these continued effects of imbalanced biological functioning," said Berarducci, who was not involved in this study.

RA severity is measured by the DAS28 — an instrument that measures the number of tender and swollen joints and the level of inflammation in the body. The DAS28 also includes a patient’s self-reported well-being. The DAS28 combines scores from these three areas – swollen/tender joints, a biological marker of inflammation and a visual analogue score (VAS) a subjective view of the patient’s overall well-being.

According to Dr. Barton and her team, anxiety and depression in RA patients are common (28-44 percent) and much higher than in the general population (6.6 percent).

To measure the impact of psychological factors on RA severity, these researchers worked with 322 patients recruited from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate (BRAGGSS), which evaluated predictors of response to biologic medications.

All of the study participants were experiencing severe RA symptoms and were about to begin treatment with anti-TNF therapy (TNF is a protein that causes inflammation) or biological therapies, including one of the following:

  • Humira (adalimumab)
  • Remicade (infliximab)
  • Cimzia (certolizumab)
  • Simponi (golimumab)
  • Enbrel (etanercept)

The patients completed three questionnaires regarding their perceptions and beliefs about their illness and its treatment along with a survey that measured anxiety and depression.

Nearly all of the participants (316) scored a median of 8 for anxiety and 7 for depression with higher being worse.

One of the subjective components of the DAS28, patient VAS, was highly correlated with cognitive factors and depression in those with severe RA. By reporting individual DAS28 components, clinicians may be better able to assess the impact of therapies on each component, adjusting approaches according to patients’ needs,” the authors concluded.

“This may seem obvious but has not been reported before and is important because without treating the depression, the patient’s DAS28 score might not improve as much as it should on a biological drug, and doctors may assume the drug is ineffective,” said Lis Cordingley, PhD, a health psychologist who was the paper's lead author.

“The high levels of anxiety and depression found in this sample may indicate that screening for these factors for patients with severe disease should be routine. This is particularly important given that psychological distress in people with RA independently predicts discontinuation of anti-TNF therapy and even mortality but, without active screening, depression may be missed,” the researchers wrote.

Dr. Barton said in a statement, “This is the first study of its kind in patients with high levels of active disease, and suggests that routinely assessing a patient's moods and beliefs — separate to their physical state — would be useful in guiding patient management. As rheumatologists we need to be aware that depression may occur more commonly in patients with severe rheumatoid arthritis than we had realized."

These findings were published in a recent issue of the journal Arthritis Care & Research.

Arthritis Research UK supported this research.

Review Date: 
January 22, 2014
Last Updated:
January 24, 2014