Depression and severity of articular destruction in patients with rheumatoid arthritis

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  • Authors: Abramkin A.A.1, Lisitsyna T.A.1, Veltishchev D.Y.2,3, Seravina O.F.2, Kovalevskaya O.B.2, Glukhova S.I.1, Nasonov E.L.1
  • Affiliations:
    1. Nasonova Research Institute of Rheumatology
    2. Moscow Research Institute of Psychiatry – branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
    3. Pirogov Russian National Research Medical University
  • Issue: Vol 92, No 5 (2020)
  • Pages: 22-32
  • Section: Original articles
  • URL: https://ter-arkhiv.ru/0040-3660/article/view/34582
  • DOI: https://doi.org/10.26442/00403660.2020.05.000624
  • Cite item

Abstract


Aim. To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA).

Materials and methods. 128 RA-patients were included, 87% were women with a mean age of 47.4±11.3 years and a median of RA duration – 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue – with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS≥4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 – сDMARDs (n=39), 2 – сDMARDs+PPT (sertraline or mianserine), n=43, 3 – сDMARDs+bDMARDs (n=32), 4 – сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants – from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction.

Results. According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPImax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only.

Conclusion. Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.


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About the authors

A. A. Abramkin

Nasonova Research Institute of Rheumatology

Author for correspondence.
Email: 79096237832@ya.ru
ORCID iD: 0000-0002-1504-5645

Russian Federation, Moscow

врач-ревматолог

T. A. Lisitsyna

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-9437-406X

Russian Federation, Moscow

вед. науч. сотр. лаб. сосудистой ревматологии

D. Yu. Veltishchev

Moscow Research Institute of Psychiatry – branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology; Pirogov Russian National Research Medical University

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-5210-2605

Russian Federation, Moscow

рук. отд-ния психических расстройств при соматических заболеваниях; проф. каф. психиатрии

O. F. Seravina

Moscow Research Institute of Psychiatry – branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-5839-4637

Russian Federation, Moscow

науч. сотр. отд-ния психических расстройств при соматических заболеваниях

O. B. Kovalevskaya

Moscow Research Institute of Psychiatry – branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology

Email: 79096237832@ya.ru

Russian Federation, Moscow

науч. сотр. отд-ния психических расстройств при соматических заболеваниях МНИИ психиатрии

S. I. Glukhova

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0002-4285-0869

Russian Federation, Moscow

науч. сотр. лаб. научно-организационных проблем ревматологии

E. L. Nasonov

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0002-1598-8360

Russian Federation, Moscow

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