Background/Purpose: There is growing evidence that complex interactions between individual’s genetic susceptibility, immunological processes, and environmental factors such as stress , increase the risk of developing Rheumatoid Arthritis (RA). For this reason, disorders associated with severe stress such as post-traumatic stress disorder (PTSD) have been implicated in various autoimmune pathologies.
Objectives :To estimate the frequency of traumatic events prior to the diagnosis of RA. To determine the frequency of PTSD in patients with traumatic events prior to the diagnosis of RA. To compare demographic, clinical, serological characteristics, existence of depression and anxiety, according to the presence or absence of PTSD.

Methods: Observational, analytical, cross-sectional study. Patients with a diagnosis of RA according to ACR (1987) and ACR EULAR (2010) criteria were included,  from the Rheumatology Service of a public hospital in Buenos Aires, Argentina. They were recruited between October 2016 and August 2018. All Patients with another rheumatic or chronic disease were excluded. To determine the presence of PTSD, the Traumatic Experiences Questionnaire was used in its version validated in Spanish. To assess the severity of PTSD, the Davidson Trauma Scale was used in its Spanish version validated for Argentina. The continuous variables were described as mean and standard deviation (SD) or median and interquartile range (IQR), according to distribution and sample size. The categorical variables were expressed in percentages.In the bivariate analysis we used, for the continuous variables, the Student or Mann Whitney test, according to distribution and sample size. The categorical variables were analyzed using Chi square or Fisher’s exact test, according to the expected frequency distribution table. A logistic regression model was performed taking PTSD as a dependent variable.

Results: 128 patients were included, 86.72% were female, with a mean age of 52.23 years (± 12.39). The mean time of evolution of RA was 12.96 years (± 9.66). 55.47% of the patients reported having experienced at least 1 traumatic event prior to the diagnosis of RA. The most frequently reported traumatic events were: unexpected death of a family member or close friend (39.5%). 32.39% of the patients who had experienced a traumatic event presented PTSD. 43.48% of patients with PTSD experienced a severe disorder.63.49% had some degree of depression and 55.56% of anxiety.
Statistically significant differences were found between the patients who presented PTSD vs those without PTSD in: female sex (100% vs 83.81%, p = 0.04), anxiety (median 12, IQR: 4-18 vs 6, IQR: 0-11 p < 0.01) depression (median 14, IQR: 6-19 vs 6, IQR: 0-12 p < 0.01). The main variable that showed an independent association with PTSD was depression (OR: 1.13, 95% CI: 1.05-1.20, p < 0.01).

Conclusion: We observed that more than half of the patients had experienced at least 1 traumatic event prior to the diagnosis of RA and 32.39% of them presented PTSD. PTSD was found associated with the female sex, the presence of anxiety and, independently,  with depression. RA is probably product of the influence of various factors, with stress being one more determinant, within many existing ones.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/post-traumatic-stress-disorder-in-patients-with-rheumatoid-arthritis/