Factors of depression among patients with rheumatoid arthritis.

Objectives: The aim of this study was to assess the correlation between symptoms of depression and the course and clinical picture of rheumatoid arthritis (RA).

Material and methods: 120 patients with RA were included in the study: 104 (87%) female patients and 16 (13%) male patients. All studied patients completed the following questionnaires: Beck Depression Inventory (BDI), Ford Insomnia Response to Stress Test (FIRST), Athens Insomnia Scale (AIS) and Health Assessment Questionnaire (HAQ). The serum levels of IL-1β, TNF-α, and IL-6 were measured using standard ELISA assays at the time of the first questionnaire assessment.

Results: Symptoms of depression were found in 91 patients (76%), including 79 (87%) women and 12 (13%) men. There were no significant differences between the prevalence of depression in women and men ( p = 0.93). Symptoms of depression occurred more often in patients who were professionally inactive, compared with the professionally active patients ( p = 0.04). Significant correlations was demonstrated between the value of BDI and the patient's pain assessed by the visual analogue scale (VAS) value ( r = 0.36), the disease activity assessed by the patient and the physician evaluated in millimetres on the VAS scale ( r = 0.38 and r = 0.30, respectively), the number of painful and swollen joints ( r = 0.22 and r = 0.26, respectively), DAS28 ( r = 0.31) as well as the Health Assessment Questionnaire (HAQ) value ( r = 0.46). Longer duration of the disease was observed in patients with symptoms of depression ( p = 0.02). Also a significant difference in the assessment of BDI between patients treated with biological drugs and those receiving no such treatment was observed ( p = 0.042).

Conclusions: Professional inactivity and longer disease duration are important factors influencing symptoms of depression in patients with RA. Higher values of HAQ increase the probability of the occurrence of depression symptoms. The use of biological drugs that reduce the level of proinflammatory cytokines may have a positive effect on reducing the severity of depressive symptoms.