Background/Purpose:  

Rheumatoid Arthritis (RA) can be associated with psychologic disorders and especially depression. About 13–20% of patients have clinical significant depression (Matcham F et al, 2013). Systemic inflammation could lead not only to inflammation in affected organs, but also mediates behavior abnormalities including depression symptoms.

Purpose: To characterise the inflammatory marker level and diseases activity in RA patients with depression.

Methods:  

176 german RA outpatients: age 62.4 ± 12.3 years, mean duration of disease 14.3 ± 10.4 years, DAS28 3.3 ± 1.3, HAQ 1.0 ± 0.75; as well 91 brazilian RA outpatients: age 56.3 ± 12.6 years, mean duration of disease 15.9 ± 8.5 years, DAS28 3.4 ± 1.51, HAQ 1.89 ± 0,85 could be included in this study. RA was diagnosed according to the ACR/EULAR Criteria 2010 and the following questionnaires were utilised: Beck depression inventary (BDI) (Beck et al., 1988), painDETECT (Freynhagen et al., 2006), visual analogue scale for pain (VAS), Short Form Health Survey (SF – 36) and Health Assessment Questionnaire (HAQ-DI). The participants were classified in 2 groups according to BDI I-II (BDI ≤ 13 – no signs of depression; BDI > 13 signs of depression) (Beck et al, 1996). The cut-off of C-reactive protein (CrP) was 5mg/l.

Results:  

About 22.9 % of german RA patients were diagnosed with associated depression. It was divided into mild (64.1 %), moderate (28.2 %) and severe depression (7.7 %). Depressive patients had a higher level of CrP compare to patients without signs of depression (7.18 ± 3.39 vs 5.25 ± 1.41, p = 0.001). There was an association between CrP and clinical symptoms of depression (BDI: r = 0.226, p = 0.003), as well as pain (VAS: r = 0.184, p = 0.017), HAQ (r = 0.291, p = 0.002) and physical quality of life (r = -0.337, p < 0.0001). In depressive patients we found higher disease activity (DAS 28) (p<0.001). Depressive patients showed 25.8% with high disease activity and 45.2% with moderate disease activity. Only 12.9% were in remission and 16.1 % in low disease activity. In patients without depressive symptoms were 43.6% in remission and 17.8% showed low disease activity. Only 5% had a high disease activity and 33.7% with moderate disease activity. Concerning to brazilien population of RA patients it was found that 44 % of patients were diagnosed with associated depression. It was divided into mild (53.7 %), moderate (29.3 %) and severe depression (17.1 %). Brazilien RA patients with mild depression showed a higher CrP-level compare to patients with moderate depression (p < 0.05). Depressive patients had higher levels of disease activity (p= 0.004). 8.3% in remission and 75% in moderate disease activity. Only 16.7% had high disease activity. In patients without depression we found 16.7% in remission and 25.0% showed low disease activity. 41.7% had moderate disease activity and 16.7% with high disease activity. 

Conclusion:

The study indicates that RA-related depression could be associated with inflammatory markers and diseases activity. In RA- population with higher prevalence of depression we could find higher CRP- levels than in population with lower prevalence. It suggests the need for management strategies that specifically target depression as part of an overall RA- management program.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-depression-in-patients-with-rheumatoid-arthritis-associated-with-disease-activity-comparative-study-between-germany-and-brazil/