Background/Purpose: Depression is an important comorbidity in patients with rheumatoid arthritis (RA). Its incidence is variable (10-25%), being more frequent in women¹. Wolfe et al. determined that pain, HAQ-DI and disease activity predict depression². The main objective is to determine depression in patients with RA by the PHQ-9 questionnaire and evaluate its relationship with disease activity.

Methods: A cross-sectional study was conducted in patients with established diagnosis of RA according to the criteria of the ACR-1988, from the Luis Vernaza Hospital and a private rheumatology center. The database included demographic data, pain visual analog scale (VAS), activity index DAS-28, HAQ-DI disability index and the PHQ-9 questionnaire. Data was loaded and analyzed in the statistical program SPSS V. 22. Statistical significance used was 0.01, with a 99% reliability.

Results: 184 patients with a mean age of 51 years (20-90) were included, 90.8% women and 9.2% men. The mean age of onset of the disease was 40 years (18-49) with a delay of visit to the specialist of 26 months (1-432). 94.6% were mestizos, 3.8%, whites and 1.6% afroecuadorians, 50% were married, 16.3%, cohabiting 16.3% divorced, 9.2% single, and 8.2% widowed. The mean patient VAS was 3.4 (0-10) and physician VAS 2.8 (0-10). The mean DAS28-CRP was 3.11 (0.7-7.6), with 44% (81) in remission, 16.8% (31) low activity, 32.1% (59) moderate activity and 7.1% (13) high activity. 21.7% (40) patients had HAQ-DI disability and 1.6% (3) severe disability. The mean PHQ-9 was 5.39 points (0-24). According to this questionnaire, depression was found in 42.9% (79), 24.5% (45) mild depression, 9.8% (18) moderate, 7.1% (13) moderate-severe and 1.6% (3) severe. Of these, 89.9% (71) were women and 10.1% (8) men. Depression related to disease activity with DAS-28. 66.7% (20) of patients in remission had mild depression while 70% (7) patients with high activity had moderate to severe depression (p = 0.009). Mean DAS-28 for patients with moderate to severe depression was higher than those with mild depression (4.0 vs. 2.9, p = 0.004) Disability also related to depression levels as 40.7% (11) patients with functional disability had moderate to severe depression, compared with 35.1% (13) patients without disability (p = 0.009). Likewise, the average HAQ of patients with major depression was higher (p = 0.000). The average patient VAS in people with mild depression was 3.7, while in moderate to severe depression was 5.4 (p = 0.000). In the physician VAS, it was 3.1 for mild depression, and 4.6 for moderate to severe depression (p = 0.000). The number of tender and swollen joints was higher in patients with major depression than in those with mild depression (p = 0.000).

Conclusion: The presence of depression was common in our population, women were the most affected. Depression was related with disability and disease activity. The presence of depression in ecuadorian patients with RA was similar to that of other populations. This is the first study of depression in patients with RA in Ecuador.

1. Rathbun, A., Harrold, R. & Reed, G. Clin Exp Rheumatol. 2014. Jul
2. Wolfe, F. & Hawley,DJ. T. The Journal of Rheumatology 1993, 20(12): 2032-2037

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