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:
  • DOI:
  • Cite item


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.
ORCID iD: 0000-0002-1504-5645

Russian Federation, Moscow


T. A. Lisitsyna

Nasonova Research Institute of Rheumatology

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

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

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


Russian Federation, Moscow

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

S. I. Glukhova

Nasonova Research Institute of Rheumatology

ORCID iD: 0000-0002-4285-0869

Russian Federation, Moscow

науч. сотр. лаб. научно-организационных проблем ревматологии

E. L. Nasonov

Nasonova Research Institute of Rheumatology

ORCID iD: 0000-0002-1598-8360

Russian Federation, Moscow


  1. Насонов Е.Л. Ревматология. Российские клинические рекомендации. М.: ГЭОТАР-Медиа, 2017 [Nasonov EL. Revmatologiya. Rossijskie klinicheskie rekomendacii. Moscow: GEOTAR-Media, 2017 (In Russ.)].
  2. Favalli EG, Becciolini A, Biggioggero M. Structural integrity versus radiographic progression in rheumatoid arthritis. RMD Open. 2015;1(Suppl. 1):e000064. doi: 10.1136/rmdopen-2015-000064
  3. Schett G, Gravallese E. Bone erosion in rheumatoid arthritis: Mechanisms, diagnosis and treatment. Nat Rev Rheumatol. 2012;8(11):656-64. doi: 10.1038/nrrheum.2012.153
  4. Чичасова Н.В. Деструкция хряща при ревматоидном артрите, связь с функциональными нарушениями. Совр. ревматология. 2014;(4):60-71 [Chichasova NV. Cartilage destruction in rheumatoid arthritis, its association with functional impairments. Modern Rheumatology Journal. 2014;8(4):60-71 (In Russ.)]. doi: 10.14412/2074-2711-2014-4-60-71
  5. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960-77. doi: 10.1136/annrheumdis-2016-210715
  6. Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis (ra) and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2013;72:600.
  7. Лисицына Т.А., Вельтищев Д.Ю. Психические расстройства у больных ревматическими заболеваниями: диагностика и лечение. Научно-практич. ревматология. 2015;53(5):512-21 [Lisitsyna TA, Veltishchev DY. Mental disorders in patients with rheumatic diseases: diagnosis and treatment. Rheumatology Science and Practice. 2015;53(5):512-21 (In Russ.)]. doi: 10.14412/1995-4484-2015-512-521
  8. Soósová MS, Macejová Ž, Zamboriová M, Dimunová L. Anxiety and depression in Slovak patients with rheumatoid arthritis. J Ment Heal. 2017 Feb;26(1):21-7. doi: 10.1080/09638237.2016.1244719
  9. Gåfvels C, Hägerström M, Rane K, et al. Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis. Heal Psychol Open. 2016;3(2):205510291667810. doi: 10.1177/2055102916678107
  10. Fiest KM, Hitchon CA, Bernstein CN, et al. Systematic Review and Meta-analysis of Interventions for Depression and Anxiety in Persons With Rheumatoid Arthritis. JCR J Clin Rheumatol. 2017;23(Issue 8): 425-34. doi: 10.1097/RHU.0000000000000489
  11. Лисицына Т.А., Вельтищев Д.Ю., Насонов Е.Л. Стрессовые факторы и депрессивные расстройства при ревматических заболеваниях. Научно-практич. ревматология. 2013;51(2):98-103 [Lisitsyna TA, Veltishchev DY, Nasonov EL. Stressors and depressive disorders in rheumatic diseases. Rheumatology Science and Practice. 2013;51(2):98-103 (In Russ.)]. doi: 10.14412/1995-4484-2013-634
  12. Ахунова Р.Р., Якупова С.П., Яхин К.К., Салихов И.Г. Пограничные психические расстройства при ревматоидном артрите (по данным опросника К.К. Яхина и Д.М. Менделевича). Научно-практич. ревматология. 2012;50(2):56-8 [Akhunova RR, Yakupova SP, Yakhin KK, Salikhov IG. Borderline psychic disorders in patients with rheumatoid arthritis (according to the data of the questionnaire of K.K. Yakhin and D.M. Mendelevich). Rheumatology Science and Practice. 2012;50(2):56-8 (In Russ.)]. doi: 10.14412/1995-4484-2012-1274
  13. Rupp I, Boshuizen HC, Dinant HJ, et al. Disability and health-related quality of life among patients with rheumatoid arthritis: Association with radiographic joint damage, disease activity, pain, and depressive symptoms. Scand J Rheumatol. 2006;35(3):175-81. doi: 10.1080/03009740500343260
  14. Euesden J, Matcham F, Hotopf M, et al. The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis. Psychosom Med. 2017;79(6):638-45. doi: 10.1097/PSY.0000000000000462
  15. Kronisch C, McLernon DJ, Dale J, et al. Brief Report: Predicting Functional Disability: One-Year Results From the Scottish Early Rheumatoid Arthritis Inception Cohort. Arthritis Rheumatol. 2016;68(7):1596-602. doi: 10.1002/art.39627
  16. Katz P. Fatigue in Rheumatoid Arthritis. Curr Rheumatol Rep. 2017;19(5):25. doi: 10.1007/s11926-017-0649-5
  17. Curtis JR, Bykerk VP, Aassi M, Schiff M. Adherence and persistence with methotrexate in rheumatoid arthritis: A systematic review. J Rheumatol. 2016;43(11):1997-2009. doi: 10.3899/jrheum.151212
  18. Rathbun AM, Harrold LR, Reed GW. Temporal effect of depressive symptoms on the longitudinal evolution of rheumatoid arthritis disease activity. Arthritis Care Res. 2015;67(6):765-75. doi: 10.1002/acr.22515
  19. Matcham F, Norton S, Scott DL, et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2015;(September 2015):269-78. doi: 10.1093/rheumatology/kev306
  20. Hider SL, Tanveer W, Brownfield A, et al. Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Rheumatology. 2009;48(9):1152-4. doi: 10.1093/rheumatology/kep170
  21. Michelsen B, Kristianslund EK, Sexton J, et al. Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis. 2017;76(11):1906-10. doi: 10.1136/annrheumdis-2017-211284
  22. Абрамкин А.А. Влияние коморбидных психических расстройств на эффективность терапии у больных ревматоидным артритом. Научно-практич. ревматология. 2016;54(3):339-45 [Abramkin AA. Impact of comorbid mental disorders on the efficiency of therapy in patients with rheumatoid arthritis. Rheumatology Science and Practice. 2016;54(3):339-45 (In Russ.)]. doi: 10.14412/1995-4484-2016-339-345
  23. Matcham F, Ali S, Irving K, et al. Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study. BMC Musculoskelet Dis. 2016;17(1):155. doi: 10.1186/s12891-016-1011-1
  24. Schmidt FM, Schröder T, Kirkby KC, et al. Pro- and anti-inflammatory cytokines, but not CRP, are inversely correlated with severity and symptoms of major depression. Psychiatry Res. 2016;239:85-91. doi: 10.1016/j.psychres.2016.02.052
  25. Haapakoski R, Mathieu J, Ebmeier KP, et al. Cumulative meta-analysis of interleukins 6 and 1β, tumour necrosis factor α and C-reactive protein in patients with major depressive disorder. Brain Behav Immun. 2015;49:206-15. doi: 10.1016/j.bbi.2015.06.001
  26. Duivis HE, Vogelzangs N, Kupper N, et al. Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: Findings from the netherlands study of depression and anxiety (NESDA). Psychoneuroendocrinology. 2013;38(9):1573-85. doi: 10.1016/j.psyneuen.2013.01.002
  27. Petersen LE, Baptista TSA, Molina JK, et al. Cognitive impairment in rheumatoid arthritis: role of lymphocyte subsets, cytokines and neurotrophic factors. Clin Rheumatol. January 2018. doi: 10.1007/s10067-018-3990-9
  28. Caneo C, Marston L, Bellón JÁ, King M. Examining the relationship between physical illness and depression: Is there a difference between inflammatory and non inflammatory diseases? A cohort study. Gen Hosp Psychiatry. 2016;43:71-7. doi: 10.1016/j.genhosppsych.2016.09.007
  29. Ozgonenel L, Cetin E, Tutun S, et al. The relation of serum vascular endothelial growth factor level with disease duration and activity in patients with rheumatoid arthritis. Clin Rheumatol. 2010;29(5):473-7. doi: 10.1007/s10067-009-1343-4
  30. Szekanecz Z, Koch AE. VEGF as an activity marker in rheumatoid arthritis. Int J Clin Rheumatol. 2010;5(3):287-9. doi: 10.2217/IJR.10.24
  31. Strawbridge R, Young AH, Cleare AJ. Biomarkers for depression: Recent insights, current challenges and future prospects. Neuropsychiatr Dis Treat. 2017;13:1245-62. doi: 10.2147/NDT.S114542
  32. Geusens P. The role of RANK ligand/osteoprotegerin in rheumatoid arthritis. Ther Adv Musculoskelet Dis. 2012;4(4):225-33. doi: 10.1177/1759720X12438080
  33. Cocchi M, Tonello L, Gabrielli F, Pregnolato M. Depression, osteoporosis, serotonin and cell membrane viscosity between biology and philosophical anthropology. Ann Gen Psychiatry. 2011;10:9. doi: 10.1186/1744-859X-10-9
  34. Hulejová H, Andrés Cerezo L, Kuklová M, et al. Novel adipokine fibroblast growth factor 21 is increased in rheumatoid arthritis. Physiol Res. 2012;61(5):489-94. doi: 932324 [pii]
  35. Sato H, Kazama JJ, Murasawa A, et al. Serum Fibroblast Growth Factor 23 (FGF23) in Patients with Rheumatoid Arthritis. Intern Med. 2016;55(2):121-6. doi: 10.2169/internalmedicine.55.5507
  36. Gururajan A, Clarke G, Dinan TG, Cryan JF. Molecular biomarkers of depression. Neurosci Biobehav Rev. 2016;64:101-33. doi: 10.1016/ j.neubiorev.2016.02.011
  37. Яльцева Н.В., Григорьева Е.А., Коршунов Н.И. Применение антидепрессантов у больных ревматоидным артритом с коморбидной депрессией. Научно-практич. ревматология. 2009;(1):43-9 [Yaltse- va NV, Grigorjeva EA, Korshunov NI. Antidepressants administration in rheumatoid arthritiswith comorbid depression. Rheumatology Science and Practice. 2009;47(1):43-9 (In Russ.)]. doi: 10.14412/1995-4484-2009-141
  38. Абрамкин А.А., Лисицына Т.А., Вельтищев Д.Ю. и др. Влияние адекватной психофармакотерапии на эффективность лечения больных ревматоидным артритом. Научно-практич. ревматология. 2018;56(2):173-83 [Abramkin AA, Lisitsyna TA, Veltishchev DY, et al. The impact of adequate psychopharmacotherapy on the efficiency of treatment in patients with rheumatoid arthritis. Rheumatology Science and Practice. 2018;56(2):173-83 (In Russ.)]. doi: 10.14412/1995-4484-2018-173-183
  39. Абрамкин А.А., Лисицына Т.А., Вельтищев Д.Ю. и др. Факторы, влияющие на эффективность терапии у больных ревматоидным артритом: роль коморбидной психической и соматической патологии. Научно-практич. ревматология. 2018;56(4):439-48 [Abram- kin AA, Lisitsyna TA, Veltishchev DY, et al. Factors influencing the efficiency of therapy in patients with rheumatoid arthritis: the role of comorbid mental and somatic diseases. Rheumatology Science and Practice. 2018;56(4):439-48 (In Russ.)]. doi: 10.14412/1995-4484-2018-439-448
  40. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81. doi: 10.1002/art.27584
  41. Амирджанова В.Н., Койлубаева Г.Н., Горячев Д.В. и др. Валидация русско-язычной версии Health Assessment Questionnaire (HAQ). Научно-практич. ревматология. 2004;(2):59-64 [Amirdjanova VN, Koilubaeva GM, Goryachev DV, et al. Validation of Russian version of Health Assessment Questionnaire (HAQ) Rheumatology Science and Practice. 2004;(2):59-64 (In Russ.)].
  42. Fransen J, van Riel PLCM. The Disease Activity Score and the EULAR Response Criteria. Rheum Dis Clin North Am. 2009;35(4):745-57. doi: 10.1016/j.rdc.2009.10.001
  43. Van Gestel AM, Prevoo ML, van’t Hof MA, et al. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum. 1996;39(1):34-40.
  44. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.
  45. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5.
  46. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-9.
  47. Лурия А.Р. Высшие корковые функции человека и их нарушения при локальных поражениях мозга. 2-е изд. М.: Изд-во МГУ, 1962 [Lu-¬ rija AR. Vysshie korkovye funkcii cheloveka i ih narushenija pri lokal’nyh porazhenijah mozga. 2nd ed. Moscow: Izd-vo MGU, 1962 (In Russ.)].
  48. Херсонский Б.Г. Метод пиктограмм в психодиагностике психических заболеваний. К.: Здоровья. 1988 [Hersonskij BG. Metod piktogramm v psihodiagnostike psihicheskih zabolevanij. Kiev: Zdorov’ja. 1988 (In Russ.).]
  49. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO; 1993. doi: 10.1002/1520-6505(2000)9:5<201::AID-EVAN2>3.3.CO;2-P
  50. Зейгарник Б.В. Патология мышления. 2-е изд. М.: Изд-во МГУ, 1962 [Zejgarnik BV. Patologija Myshlenija. 2nd ed. Moscow: Izd-vo MGU, 1962 (In Russ.)].
  51. Альманах психологических тестов. 3-е изд. М.: КСП, 1995 [Al’manah psihologicheskih testov. 3rd ed. Moscow: KSP, 1995 (In Russ.)].
  52. Рубинштейн С.Я. Экспериментальные методики патопсихологии и опыт применения их в клинике. Под ред. Г. Бутенко. М.: Изд-во Института психотерапии, 2010 [Rubinshtejn S.Ja. Jeksperimental’nye metodiki patopsihologii i opyt primenenija ih v klinike. Butenko G, ed. Moscow: Izd-vo Instituta psihoterapii, 2010 (In Russ.)].
  53. American Psychiatric Association, American Psychiatric Association. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association, 2000.
  54. Герасимов А.Н. Медицинская статистика. Учебное пособие. М.: Медицинское информационное агентство, 2007 [Gerasimov AN. Medicinskaja Statistika: Uchebnoe Posobie. Moscow: Medicinskoe informacionnoe agentstvo, 2007 (In Russ.)].
  55. Абрамкин А.А., Лисицына Т.А., Вельтищев Д.Ю. и др. Влияние синтетических базисных противовоспалительных препаратов, генно-инженерных биологических препаратов и психофармакологической терапии на динамику психических расстройств у больных ревматоидным артритом. Научно-практич. ревматология. 2017;55(4):393-402 [Abramkin AA, Lisitsyna TA, Veltishchev DY, et al. Effects of synthetic disease-modifying antirheumatic drugs, biological agents, and psychopharmacotherapy on the mental disorders in patients with rheumatoid arthritis. Rheumatology Science and Practice. 2017;55(4):393-402 (In Russ.)]. doi: 10.14412/1995-4484-2017-393-402
  56. Tegethoff M, Stalujanis E, Belardi A, Meinlschmidt G. Chronology of onset of mental disorders and physical diseases in mental-physical comorbidity – A national representative survey of adolescents. PLoS One. 2016;11(10):e0165196. doi: 10.1371/journal.pone.0165196
  57. Marrie RA, Walld R, Bolton JM, et al. Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease. Epidemiol Psychiatr Sci. 2017:1-10. doi: 10.1017/S2045796017000579
  58. Zhang L, Wang J, Zhang Q, et al. Factors associated with hand joint destruction in Chinese patients with rheumatoid arthritis. BMC Musculoskelet Dis. 2017;18(1):211. doi: 10.1186/s12891-017-1548-7
  59. Karpouzas GA, Draper T, Moran R, et al. Trends in functional disability and determinants of clinically meaningful change over time in Hispanics with Rheumatoid arthritis in the United States. Arthritis Care Res (Hoboken). 2016;69(2):294-8. doi: 10.1002/acr.22924
  60. Wolfe F, Michaud K. Predicting depression in rheumatoid arthritis: The signal importance of pain extent and fatigue, and comorbidity. Arthritis Care Res. 2009;61(5):667-73. doi: 10.1002/art.24428

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