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Fagni F, Motta F, Schett G, Selmi C. Difficult-to-Treat Psoriatic Arthritis: A Conceptual Approach. Arthritis Rheumatol 2024; 76:670-674. [PMID: 38108094 DOI: 10.1002/art.42780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Filippo Fagni
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Francesca Motta
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carlo Selmi
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
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Ionescu CE, Popescu CC, Agache M, Dinache G, Codreanu C. Depression in Rheumatoid Arthritis: Prevalence and Effects on Disease Activity. J Clin Med 2024; 13:2058. [PMID: 38610822 PMCID: PMC11012436 DOI: 10.3390/jcm13072058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background:The primary objective of this study was to estimate depression's prevalence in a cohort of rheumatoid arthritis (RA) patients, and the secondary objective was to evaluate the impact of depression on disease activity over time. Methods: We included all patients with RA presenting to our clinic from 2019 to 2020, who had three follow-up visits available. Depression prevalence was calculated using the patient's history of diagnosed depression, and disease activity was assessed using the disease activity score for 28 joints (DAS28) and its components: tender joint count (TJC), swollen joint count (SJC), pain value on a visual analog scale (VAS), and inflammatory markers. Results: A total of 400 RA patients were included, 75 of whom had diagnosed depression, generating a prevalence of 18.8%. The mean values of DAS28 and its components were higher, with statistical significance, in the depression subgroup at all three follow-ups (p < 0.001). Conclusions: Depression is prevalent in the RA population, and leads to higher disease activity in dynamic evaluations. Assessing depression could be a psychological marker for RA prognosis with an important outcome in controlling disease activity.
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Affiliation(s)
- Cătălina-Elena Ionescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu Costinel Popescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Mihaela Agache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Georgiana Dinache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Cătălin Codreanu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-E.I.); (M.A.); (G.D.); (C.C.)
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
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Hasan MA, Almogaliq WS, Alhanabi FH, Aldrazi HA, Alkhouzaie MT, Albukhari R, Alqatari S, Al-Abdulwahab AA, AlZuhair HM, Al-Hariri MT. Anxiety and Depression and Associated Risk Factors among Outpatients with Systemic Lupus Erythematosus: Eastern Province, Saudi Arabia. Clin Pract 2024; 14:486-497. [PMID: 38525716 PMCID: PMC10961743 DOI: 10.3390/clinpract14020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Although mood disorders are prevalent among systemic lupus erythematosus (SLE) patients, they are usually underrecognized. This study aimed to estimate the prevalence of anxiety and depression among Saudi SLE patients. METHODS This cross-sectional study was conducted among SLE patients from July 2022 to June 2023 in the Eastern Province of Saudi Arabia. A self-reported questionnaire was used to collect the data through validated tools including the Hamilton Anxiety Rating Scale-A and the Beck Depression Inventory score. RESULTS There were 133 females (91.7%) and 12 males (8.3%) included in this study. Based on the HAM-A score, 45.5% of participants had an anxiety disorder, and according to the BDI score, 46.2% had a depression disorder. Anxiety and depression were significantly associated with a longer duration of SLE, unemployment status, smoking, and the presence of comorbidities. Moreover, the present study found a significant association between depression and male gender. CONCLUSION This study found that Saudi SLE patients have a high prevalence of both anxiety and depression. Therefore, SLE patients should be screened for neuropsychiatric disorders during routine follow-ups and managed as early as possible.
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Affiliation(s)
- Manal Ahmed Hasan
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Wasayf Salman Almogaliq
- Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34224, Saudi Arabia; (W.S.A.); (F.H.A.); (H.A.A.)
| | - Fatimah Habib Alhanabi
- Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34224, Saudi Arabia; (W.S.A.); (F.H.A.); (H.A.A.)
| | - Hebah Abbas Aldrazi
- Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34224, Saudi Arabia; (W.S.A.); (F.H.A.); (H.A.A.)
| | - Moath Thamer Alkhouzaie
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Raed Albukhari
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Safi Alqatari
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Abdullah A. Al-Abdulwahab
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Hajer Musaab AlZuhair
- Department of Internal Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.H.); (M.T.A.); (R.A.); (S.A.)
| | - Mohammed T. Al-Hariri
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34224, Saudi Arabia
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Haberman RH, Zhou YY, Catron S, Felipe A, Jano K, Reddy SM, Scher JU. Psychosocial Factors Significantly Contribute to Joint Pain Persistence in Psoriatic Arthritis. J Rheumatol 2024; 51:318-320. [PMID: 38428986 PMCID: PMC10914320 DOI: 10.3899/jrheum.2023-0909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Rebecca H Haberman
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York;
| | - Ying Yin Zhou
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
| | - Sydney Catron
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
| | - Adamary Felipe
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
| | - Kathryn Jano
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
| | - Soumya M Reddy
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York
- Colton Center for Autoimmunity, NYU Grossman School of Medicine, New York, New York, USA
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5
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Roseman C, Wallman JK, Jöud A, Schelin M, Einarsson JT, Lindqvist E, Lampa J, Kapetanovic MC, Olofsson T. Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: what is the role of inflammation control? Scand J Rheumatol 2024; 53:94-103. [PMID: 38031733 DOI: 10.1080/03009742.2023.2258644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. METHOD Bionaïve PsA patients starting a first anti-TNF therapy 2004-2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression. RESULTS Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator's global assessment were associated with a lower risk of 12-month refractory pain. CONCLUSIONS A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.
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Affiliation(s)
- C Roseman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - J K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - A Jöud
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Mec Schelin
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
- Department of Research and Development, Skåne University Hospital, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - J T Einarsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - E Lindqvist
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - J Lampa
- Karolinska Institute, Department of Medicine Solna, Rheumatology Unit, Center of Molecular Medicine (CMM), Stockholm, Sweden
| | - M C Kapetanovic
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - T Olofsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
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Lin CY, Chang H, Kung TC, Wei JCC. The link among alcohol consumption, disease progression, and quality of life in rheumatoid arthritis: comment on the article by Alfredsson et al. Arthritis Rheumatol 2024; 76:486-487. [PMID: 37732937 DOI: 10.1002/art.42720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Affiliation(s)
| | - Hsuan Chang
- Chung Shan Medical University, Taichung, Taiwan
| | | | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Zheng Y, Hou Z, Ma S, Huang Z, Peng J, Huang S, Guo R, Huang J, Lin Z, Zhuang Z, Yin J, Xie L. Altered dynamic functional network connectivity in rheumatoid arthritis associated with peripheral inflammation and neuropsychiatric disorders. RMD Open 2024; 10:e003684. [PMID: 38428977 PMCID: PMC10910624 DOI: 10.1136/rmdopen-2023-003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This study explored the dynamic functional connective (DFC) alterations in patients with rheumatoid arthritis (RA) and investigated the correlation between the neuropsychiatric symptoms, peripheral inflammation and DFC alterations. METHOD Using resting-state functional MRI, we investigated the DFC based on spatial independent component analysis and sliding window method for 30 patients with RA and 30 healthy controls (HCs). The Spearman correlation was calculated between aberrant DFC alterations, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HAD), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Diagnostic efficacy of indicators was assessed using receiver operating characteristic analysis (ROC). RESULTS Three dynamic functional states were identified. Compared with HC, patients with RA showed reduced FC variabilities between sensorimotor network (SMN) and insula, SMN and orbitofrontal cortex, which were the crucial regions of sensory processing network. The above FC variabilities were correlated with the MoCA, HAD, CRP and ESR in patients with RA. Additionally, the CRP and ESR were negatively correlated to MoCA and positively related to HAD in patients with RA. The ROC analysis results showed that MoCA, HAD and FC variabilities of the sensory processing network could distinguish patients with RA from HC and also identify patients with RA with high ESR. CONCLUSION Our findings demonstrated that abnormal DFC patterns in sensory processing networks in patients with RA were closely associated with peripheral inflammation and neuropsychiatric symptoms. This indicates that the dynamic temporal characteristics of the brain functional network may be potential neuroimaging biomarkers for revealing the pathological mechanism of RA.
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Affiliation(s)
- Yanmin Zheng
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiduo Hou
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zikai Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jianhua Peng
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuxin Huang
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ruiwei Guo
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jinzhuang Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhirong Lin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zelin Zhuang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jingjing Yin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lei Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Snoeck Henkemans SVJ, de Jong PHP, Luime JJ, Kok MR, Tchetverikov I, Korswagen LA, van der Kooij SM, van Oosterhout M, Baudoin P, Bijsterbosch J, van der Kaap JH, van der Helm-van Mil AHM, Vis M. Window of opportunity in psoriatic arthritis: the earlier the better? RMD Open 2024; 10:e004062. [PMID: 38413172 PMCID: PMC10900390 DOI: 10.1136/rmdopen-2023-004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay. METHODS All newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients who participated in the Dutch southwest Early PsA cohoRt and had ≥3 years of follow-up were studied. First, total delay was calculated as the time period between symptom onset and PsA diagnosis made by a rheumatologist and then split into patient and physician delays. The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). These groups were compared on clinical (Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up. RESULTS 708 PsA patients were studied of whom 136 (19%), 237 (33%) and 335 (47%) had a short, intermediate and long total delay, respectively. Patient delay was 1.0 month and physician delay was 4.5 months. Patients with a short delay were more likely to achieve MDA (OR 2.55, p=0.003) and DAPSA remission (OR 2.35,p=0.004) compared with PsA patients with a long delay. Patient-reported outcomes showed numerical but non-significant differences between the short and long delay groups. Female patients and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP) had a longer delay. CONCLUSIONS In PsA, referral and diagnosis within 1 year is associated with better clinical outcomes, suggesting the presence of a window of opportunity. The most gain in referral could be obtained in physician delay and in females, patients with enthesitis, chronic back pain or normal CRP.
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Affiliation(s)
| | | | | | - Marc R Kok
- Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Paul Baudoin
- Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | | | | | | | - Marijn Vis
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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Citera G, Jain R, Irazoque F, Madariaga H, Gruben D, Wang L, Stockert L, Santana K, Ebrahim A, Ponce de Leon D. Tofacitinib Efficacy in Patients with Rheumatoid Arthritis and Probable Depression/Anxiety: Post Hoc Analysis of Phase 3 and 3b/4 Randomized Controlled Trials. Rheumatol Ther 2024; 11:35-50. [PMID: 37925660 PMCID: PMC10796892 DOI: 10.1007/s40744-023-00612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The aim of our work is to assess the prevalence of probable major depressive disorder and/or probable generalized anxiety disorder (pMDD/pGAD) in patients with moderate to severe rheumatoid arthritis (RA), and to evaluate the efficacy of tofacitinib on RA symptoms stratified by baseline pMDD/pGAD status. METHODS Data were pooled from five phase 3 randomized controlled trials (RCTs) and one phase 3b/4 RCT, assessing tofacitinib 5 or 10 mg twice daily (BID), adalimumab (two RCTs), or placebo. pMDD/pGAD was defined as Short Form-36 Health Survey (SF-36) Mental Component Summary (MCS) score ≤ 38. Efficacy outcomes over 12 months included least squares mean change from baseline in SF-36 MCS score and Health Assessment Questionnaire-Disability Index, proportions of patients with pMDD/pGAD in those with baseline pMDD/pGAD, and American College of Rheumatology 20/50/70 response, and Disease Activity Score in 28 joints, erythrocyte sedimentation rate remission (< 2.6) rates. RESULTS A total of 4404 patients with non-missing baseline values were included. Baseline pMDD/pGAD was reported by 44.5%, 39.8%, 45.4%, and 39.1% of patients receiving tofacitinib 5 mg BID, tofacitinib 10 mg BID, adalimumab, and placebo, respectively. SF-36 MCS improvements were greater for tofacitinib versus adalimumab/placebo through month 6, with numerical improvements for tofacitinib versus adalimumab sustained through month 12, when the proportions of patients with baseline pMDD/pGAD who continued to have pMDD/pGAD were reduced. RA efficacy outcomes were generally similar in patients with/without baseline pMDD/pGAD. CONCLUSIONS The percentage of patients with pMDD/pGAD reduced from baseline over 1 year of treatment with tofacitinib or adalimumab. Effective treatment of underlying RA may lead to improvements in depression and anxiety, based on the SF-36 MCS. Specially designed studies using gold-standard diagnostic tools would be warranted to investigate this further. Video Abstract available for this article. TRIAL REGISTRATION NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT02187055. Video Abstract (MP4 204475 KB).
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Affiliation(s)
- Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Rakesh Jain
- Texas Tech University School of Medicine, Permian Basin, Midland, TX, USA
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Martins A, Oliveira D, Nicolau R, Rocha TM, Bernardo A, Costa L, Pimenta S, Bernardes M. What is the association of depression with clinical response to therapy in patients with psoriatic arthritis treated with biologic disease-modifying antirheumatic drugs? Clin Rheumatol 2024; 43:251-258. [PMID: 37957488 DOI: 10.1007/s10067-023-06806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, progressive inflammatory joint disease that is associated with higher prevalence of depression. There is limited literature about the impact of depression, particularly regarding the response to therapy. METHODS A retrospective cohort study with PsA patients that started their first biologic disease-modifying antirheumatic drugs (bDMARD) was conducted. In the majority of cases, a cutoff score of ≥ 8 in Hospital Anxiety and Depression Scale (HADS) was used to define cases of depression. In cases where patients did not complete the questionnaire, a previous diagnosis made by a psychiatrist was used to establish the presence of depression. Response to therapy 12 months after the start of bDMARD was evaluated and the switch rate to another bDMARD due to inefficacy was assessed at month 12. RESULTS A total of 129 patients (66 females, 51.2%; mean age of 47.7 ± 11.0 years and mean disease duration of 10.0 ± 7.7 years) with PsA were included. Thirty-two (24.8%) patients had depression. Patients with depression and peripheral involvement had a significantly lower ACR20/50/70 responses (p = 0.001, p = 0.002, and p = 0.001 respectively) after 12 months of therapy and a significantly worse EULAR response (p = 0.002). Furthermore, patients with depression and axial involvement had a significantly worse response based on ASDAS response criteria (p = 0.031). Switch due to ineffectiveness in the first 12 months was significantly higher in patients with depression (p = 0.002). CONCLUSION Depression in PsA is a frequent yet often understudied comorbidity. The causal relationship between depression and PsA is difficult to decrypt and further research is needed. Recognition of depressive symptoms is crucial and a multidisciplinary approach should be provided to individuals with this comorbidity. Key Points • Depression in PsA is a frequent yet often understudied comorbidity. In our study, the prevalence of depression was 24.8%. • Depression in PsA seems to be associated to lower response to therapy and higher discontinuation rates of bDMARD. • Recognition of depressive symptoms is crucial and a multidisciplinary approach should be provided to individuals with this comorbidity.
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Affiliation(s)
- Ana Martins
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal.
- Rheumatology Department, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Daniela Oliveira
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rafaela Nicolau
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Teresa Martins Rocha
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alexandra Bernardo
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lúcia Costa
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Pimenta
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Miguel Bernardes
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Chen HH, Wu PY, Lin CH, Wu CL, Chao WC. Factors associated with mental illness in patients with rheumatoid arthritis initiating b/ts DMARDs: A population-based study. Int J Rheum Dis 2024; 27:e14992. [PMID: 38061767 DOI: 10.1111/1756-185x.14992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
AIM Mental health is an essential issue in patients with rheumatoid arthritis (RA) but remains unclear among those receiving biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). We aim to assess the incidence and factors associated with mental illness among patients with RA who underwent b/tsDMARD therapy. METHOD We used Taiwan's National Health Insurance Research Database for the period 2001-2020 to identify patients with RA receiving b/tsDMARDs. The primary outcome was newly developed mental illness, including anxiety and mood disorders. We performed a Cox regression analysis to determine factors associated with mental illness and presented as hazard ratios (HR) with 95% confidence interval (CI). RESULTS We enrolled 10 852 patients, with 7854 patients receiving tumor necrosis factors inhibitors (TNFi), 1693 patients receiving non-TNFi bDMARDs, and 1305 patients treated with tsDMARD. We found that 13.62% of enrolled patients developed mental illness, with an incidence rate of 4054 per 100 000 person-year. Those receiving tocilizumab (aHR 0.64, 95% CI: 0.51-0.82), abatacept (aHR 0.69, 95% CI: 0.55-0.86), or tsDMARDs (aHR 0.58, 95% CI: 0.47-0.73) had a lower risk of mental illness compared with those receiving TNFi. We also found that old age, low income, diabetes mellitus, use of cyclosporine, and use of steroids were associated with incident mental illness. CONCLUSION This population-based study investigated the incidence and factors associated with mental illness among patients with RA receiving b/tsDMARDs. Our findings highlight the need for vigilance with respect to the possibility of mental illness in patients with RA.
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Affiliation(s)
- Hsin-Hua Chen
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Big Data Center, Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Peng-Yen Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chieh-Liang Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Cheng Chao
- Big Data Center, Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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12
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Tidblad L, Westerlind H, Delcoigne B, Askling J, Saevarsdottir S. Comorbidities and chance of remission in patients with early rheumatoid arthritis receiving methotrexate as first-line therapy: a Swedish observational nationwide study. RMD Open 2023; 9:e003714. [PMID: 38123483 DOI: 10.1136/rmdopen-2023-003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES This study aims to examine whether comorbidities affect the likelihood of reaching primary remission on methotrexate monotherapy as the first disease-modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA). METHODS We used nationwide Swedish clinical and quality registers to collect RA disease activity measures and comorbidity data for patients diagnosed with RA 2007-2020 (n=11 001). The primary outcome was failure to reach 28-joint Disease Activity Score (DAS28) remission at 3 months. Secondary outcomes included Boolean, Simplified Disease Activity Index/Clinical Disease Activity Index remission, European Alliance of Associations for Rheumatology response and no swollen joint count at 3 and 6 months. For each comorbidity, and for combinations thereof, we calculated adjusted relative risks (RRs) of failure to reach remission, using modified Poisson regression. RESULTS In total, 53% (n=4019/7643) failed to reach DAS28 remission after 3 months of methotrexate monotherapy, ranging from 66% (n=25/38) among patients with chronic kidney disease to 48% (n=154/319) in patients with previous cancer. The risk of not reaching DAS28 remission at 3 months (RR adjusted for sex and age) was increased among patients with endocrine (RR 1.08, 95% CI 1.01 to 1.15), gastrointestinal (RR 1.16, 95% CI 1.03 to 1.30), infectious (RR 1.21, 95% CI 1.06 to 1.38), psychiatric (RR 1.24, 95% CI 1.15 to 1.35) and respiratory comorbidities (RR 1.16, 95% CI 1.01 to 1.32). Having three or more comorbidity categories was associated with a 27% higher risk of DAS28 remission failure at 3 months. A similar pattern was observed for the secondary outcomes. CONCLUSIONS Comorbidities decrease the chance of reaching remission on methotrexate as DMARD monotherapy in patients with early RA and are important to consider when assessing treatment outcomes.
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Affiliation(s)
- Liselotte Tidblad
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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13
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Philippoteaux C, Marty-Ane A, Cailliau E, Labreuche J, Philippe P, Cortet B, Paccou J, Flipo RM, Letarouilly JG. Characteristics Of Difficult-To-Treat Psoriatic Arthritis: A Comparative Analysis. Semin Arthritis Rheum 2023; 63:152275. [PMID: 37852155 DOI: 10.1016/j.semarthrit.2023.152275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The EULAR task force recently published the difficult-to-treat rheumatoid arthritis (D2T RA) criteria, however, a definition of D2T patients in psoriatic arthritis (PsA) is still lacking. To date, we have little data concerning D2T PsA, especially in real-world. One of the limitations of the D2T RA EULAR definition is the absence of a temporal criterion. The primary endpoint of this work was to study the characteristics of D2T PsA patients using the EULAR definition. The second objective was to study a sub-group of patients with a predefined more stringent definition including a temporal criterion. METHODS A retrospective study was performed in a tertiary center. D2T PsA was defined as failure of ≥ 2 b/tsDMARDs with different mechanism of action. Very D2T PsA was defined as failure of ≥ 2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T PsA patients were compared to nD2T PsA patients using statistical tests. RESULTS 150 PsA patients were included (from 2004 to 2015): 49 D2T PsA and 101 nD2T PsA. D2T PsA was associated with a higher prevalence of axial involvement (p=0.030), axial and/or peripheral structural damage (p=0.007) at baseline and more bDMARDs discontinuation due to poor dermatological control (p=0.005). There was no significant difference regarding comorbidities such as obesity, smoking status, fibromyalgia or depression. In multivariate analysis, peripheral structural damage at baseline was found to be a predictive factor for D2T PsA with an OR of 2.57 (1.16 to 5.69; p=0.020). 17 PsA (11.3%) patients were categorized as Very D2T PsA. When compared to nD2T group, proportion of obesity was higher (p=0.015) and axial involvement was more prevalent in the Very D2T group (p=0.020). CONCLUSION D2T PsA patients had a higher prevalence of axial involvement, peripheral structural damage and therapeutic discontinuation due to poor dermatological control whereas Very D2T PsA patients were more likely obese with axial involvement. Very D2T PsA represent a minim proportion among patients when applying a more stringent definition. Pending the PsA D2T definition by the European and American societies, this study highlights some characteristics that may help practitioners better identify D2T patients.
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Affiliation(s)
| | - Anne Marty-Ane
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Emeline Cailliau
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Julien Labreuche
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Peggy Philippe
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Bernard Cortet
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Julien Paccou
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Rene-Marc Flipo
- Rheumatology Department, Lille University Hospital, Lille, France
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14
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Zhang L, Zhu W, Wu B. Determinants of Depressive Symptoms Among Patients with Rheumatoid Arthritis in China: A Structural Equation Model. Psychol Res Behav Manag 2023; 16:4197-4208. [PMID: 37868652 PMCID: PMC10590068 DOI: 10.2147/prbm.s428892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background This study aimed to examine how personality traits, social support and clinical features including pain, disease activity, functional status, sleep quality, and fatigue influence on depressive symptoms in Chinese rheumatoid arthritis (RA) patients. Methods This study was conducted from November, 2022 to June, 2023 among Chinese RA patients. Pain, disease activity, functional status, sleep quality, fatigue, social support, personality traits, and depressive symptoms were assessed. The following relationships among three hypotheses were analyzed by structural equation model (SEM): H1: clinical features have a direct effect on depressive symptoms; H2: personality traits might work as a mediator between clinical features and depression; H3: social support is related to depressive symptoms, being a direct effect or an indirect effect through clinical features or personality traits. Results The final model including 326 RA patients presented a good fit (χ2=103, χ2/df=1.69; GFI=0.96; AGFI=0.93; CFI=0.97; TLI=0.96; RMSEA=0.046). Clinical features had a total effect of 0.59 on depressive symptoms, of which β=0.33 (P=0.013) was an indirect effect through personality traits, indicating a mediating influence between this relationship; moreover, there was a significant direct association between clinical features and depressive symptoms (β=0.26; P=0.022). Personality traits (β=-0.65; P<0.001) had a much stronger relation with depressive symptoms than with clinical features. Social support had a total effect of 0.81 on personality traits, being a direct effect of β=0.52 (P<0.001) and an indirect effect of β=0.29 (P<0.001) through clinical features. The final proposed model explained 77% of the variance of depressive symptoms. Conclusion Personality traits had a considerable influence upon depressive symptoms, while social support seemed to have a major effect on personality traits. It is necessary to apply comprehensive assessment and interventions of patients' personality traits, clinical features, as well as social support, which could optimize their mental health.
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Affiliation(s)
- Lijuan Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Beiwen Wu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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15
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Milo F, Angelino G, Romeo EF, De Angelis P, Tabarini P. Depression symptoms increase the risk for initiation or switching to biologic therapy in pediatric inflammatory bowel disease patients in remission. BMC Gastroenterol 2023; 23:355. [PMID: 37833631 PMCID: PMC10571381 DOI: 10.1186/s12876-023-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIMS Anxiety and depression symptoms are common in IBD population, both adult and pediatric patients. Increased psychological distress might contribute to initiation and switching to biologic therapy in adult patients with IBD or other chronic inflammatory diseases. Aim of the present study are to evaluate anxiety and depression symptoms in IBD pediatric patients with disease remission and investigate their role in initiation or switching to biologic therapy. METHODS We performed a retrospective analysis on IBD pediatric patients, assessing for anxiety (GAD-7) and depression (PHQ-9) symptoms. Demographic and disease characteristics were obtained from medical records. RESULTS Eighty-six patients [31 (36%) females - mean age = 15.6 (SD = 2.8) years] were included. Patients scored above cut-off (> 10) on PHQ-9 and GAD-7 were 17 (19.7%) and 18 (20.9%), respectively. No differences were found between UC and CD patients. Baseline clinically relevant depression symptoms were significantly associated with the odds of initiating or switching to biologic therapy within 2 years [OR = 4.5 (1.4-14.3)], even after confounders adjustment [4.2 (1.2-14.9)]. Relationship was not significant with anxiety symptoms. CONCLUSION Anxiety and depression symptoms is relatively common in pediatric IBD population, even with disease remission. Pediatric IBD patients with high depression symptoms are at increased risk of initiating or switching to biologic therapy. Mental health screening programs should be incorporated in routine clinical practice, especially for depression, regardless of disease activity and disease type. Early diagnosis and proper intervention for mental illness should be part of routine IBD management.
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Affiliation(s)
- F Milo
- Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - G Angelino
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - E F Romeo
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P De Angelis
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P Tabarini
- Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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16
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Żuchowski P, Dura M, Kaźmierczak K, Meder G, Waszczak-Jeka M, Jeka D. Comparison of advanced glycation end products concentration in the skin among patients with rheumatic diseases, with and without comorbid depression: a case-control study. Rheumatol Int 2023; 43:1829-1834. [PMID: 37452881 DOI: 10.1007/s00296-023-05393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Patients with rheumatic diseases suffer depression at a far greater rate than the general population. Aside from evident mental health degradation, in this group of patients depression can often lead to failures in the treatment of the basic disease. The aim of the study was to assess the concentration of advanced glycation end-products (AGE) in the skin autofluorescence (SAF) exam in patients with select rheumatic diseases depending on depression concomitance. 139 patients with rheumatic diseases were enrolled into the study-43 (39F/4 M) patients with RA, 31 (24F/7 M) patients with PsA, 27 (22F/5 M) patients with SLE and 38 (33F/5 M) patients with SSc. In all patients, the concentration of AGE was assessed using the AGE Reader device (DiagnOptics BV Groningen, The Netherlands). The Beck Depression Inventory II was used to assess depression in the patients. Patients who scored 14 points or more in the BDI-II were diagnosed with depression. In the studied group, depression was identified in 73 (53%) patients-25 with RA, 21 with PsA, 11 with SLE and 16 with SSc. Mean SAF in patients with depression was 2.8 ± 0.4, and in the group with no depression-2.2 ± 0.5 (p < 0.001). The study results indicate that in the course of rheumatic diseases, the presence of depression may influence the increase in AGE concentration in the skin. Therefore, evaluating AGE levels in the skin may be clinically relevant as it can help identify patients who may be at risk of developing depression.
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Affiliation(s)
- Paweł Żuchowski
- Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No 2, Bydgoszcz, Poland.
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
| | - Marta Dura
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Radiology, Jan Biziel University Hospital No 2, Bydgoszcz, Poland
| | - Karolina Kaźmierczak
- Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
| | | | - Daniel Jeka
- Kliniczne Terapie Innowacyjne, Toruń, Poland
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17
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Shridharmurthy D, Lapane KL, Nunes AP, Baek J, Weisman MH, Kay J, Liu SH. Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study. J Rheumatol 2023; 50:1287-1295. [PMID: 37399461 DOI: 10.3899/jrheum.2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD). METHODS A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group. RESULTS Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36). CONCLUSION Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.
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Affiliation(s)
- Divya Shridharmurthy
- D. Shridharmurthy, MMBS, MPH, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Anthony P Nunes
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jonggyu Baek
- J. Baek, PhD, Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Michael H Weisman
- M.H. Weisman, MD, Division of Immunology and Rheumatology, School of Medicine, Stanford University, Palo Alto, California
| | - Jonathan Kay
- J. Kay, MD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Division of Rheumatology, Department of Medicine, UMass Chan Medical School, and Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shao-Hsien Liu
- S.H. Liu, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
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18
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Islam ST, Descallar J, Martens D, Hassett G, Gibson KA. Screening for Anxiety in Patients With Inflammatory Arthritis Using the Multidimensional Health Assessment Questionnaire. J Rheumatol 2023; 50:1273-1278. [PMID: 37399467 DOI: 10.3899/jrheum.2022-1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To analyze the Multidimensional Health Assessment Questionnaire (MDHAQ) in screening for anxiety in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compared to the Hospital Anxiety and Depression Scale (HADS) as the reference standard. METHODS Patients with a physician diagnosis of RA or PsA were invited to complete the MDHAQ and HADS at their routine rheumatology clinic visit. Sensitivity, specificity, percent agreement, and [Formula: see text] statistics were used to evaluate agreement between 2 MDHAQ items for anxiety and HADS subscale for Anxiety (HADS-A) score of ≥ 8. The first item is a question asked on a 4-point scale (0-3.3), and the second is a yes or no (blank) question asked within a 60-item review of symptoms (ROS) checklist. RESULTS The study included 183 participants, of whom 126 (68.9%) had RA and 57 (31.1%) had PsA. The mean age was 57.3 years and 66.7% were female. Positive screening for anxiety according to a HADS-A score of ≥ 8 was seen in 39.3% of patients. Compared to those with a HADS-A score of ≥ 8, patients with an MDHAQ score of ≥ 2.2 or a positive on ROS had a sensitivity of 69.9%, specificity of 73.6% and substantial agreement (agreement 80.9%, [Formula: see text] 0.59). CONCLUSION The MDHAQ provides information similar to the HADS in screening for anxiety in patients with RA and PsA. The use of this single questionnaire, which can also be used to monitor clinical status and to screen for fibromyalgia and depression without requiring multiple questionnaires, may prove a valuable tool in routine clinical practice.
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Affiliation(s)
- Sadia Tasnim Islam
- S.T. Islam, MD, Department of Rheumatology, Liverpool Hospital, Liverpool;
| | - Joseph Descallar
- J. Descallar, MBiostat, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, University of New South Wales (UNSW Sydney), Liverpool
| | - David Martens
- D. Martens, MBBS, Department of Rheumatology, Liverpool Hospital, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool
| | - Geraldine Hassett
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
| | - Kathryn Alleyne Gibson
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
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19
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Haberman RH, Um S, Catron S, Chen A, Lydon E, Attur M, Neimann AL, Reddy S, Troxel A, Adhikari S, Scher JU. Paradoxical Effects of Depression on Psoriatic Arthritis Outcomes in a Combined Psoriasis-Psoriatic Arthritis Center. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2023; 8:134-140. [PMID: 38188536 PMCID: PMC10768813 DOI: 10.1177/24755303231186405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Backgroud Psoriatic arthritis (PsA) is a chronic, inflammatory arthritis that, when left untreated, can lead to erosions, deformities and decrease in quality of life. PsA is known to be associated with multiple comorbidities, including cardiovascular, metabolic and mental health syndromes, all of which can increase its overall morbidity and mortality. Objective To characterize a cohort of patients with PsA and understand the impact of depression on PsA outcome measures. Methods 527 consecutive patients with PsA were enrolled in an observational, longitudinal registry that followed them prospectively at standard of care visits. Demographics, medical history, medication use, and clinical exam were all recorded. Results Depression was reported in 22.8% of the population, anxiety in 18%, and attention deficit hyperactivity disorder in 4%. Depression was more common in female participants (P < .001). At baseline, individuals with PsA and concomitant depression had similar tender and swollen joint counts and RAPID3 compared to those without depression, and had lower body surface area affected by psoriasis (P = .04). At year one, all patients had improvement in clinical outcomes. However, patients with depression had a significantly higher tender joint count compared to those without depression (P = .001), despite similar swollen joint count and body surface area. Conclusion In patients with depression, there is a discrepancy between improvement in physician assessed measures and patient reported outcomes. These observations underscore the importance of addressing depression and psychological distress as part of PsA treatment outcomes and points towards the need to address residual pain through co-adjuvant approaches.
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Affiliation(s)
- Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Seungha Um
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Sydney Catron
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Alan Chen
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Eileen Lydon
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Malavikalakshmi Attur
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Soumya Reddy
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, USA
- Colton Center of Autoimmunity, NYU Langone Health, New York, NY, USA
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20
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Kumthekar A, Ashrafi M, Deodhar A. Difficult to treat psoriatic arthritis - how should we manage? Clin Rheumatol 2023; 42:2251-2265. [PMID: 37097525 DOI: 10.1007/s10067-023-06605-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/18/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic, multi-domain immune-mediated inflammatory arthritis with a high disease burden. PsA patients have significant co-morbidities like obesity, depression, fibromyalgia which can impact disease activity assessment. The management of PsA has undergone a paradigm shift over the last decade due to the availability of multiple biologic and targeted synthetic disease modifying anti-rheumatic drugs. Despite the availability of multiple therapeutic agents, it is not uncommon to find patients not responding adequately and continuing to have active disease and/or high disease burden. In our review, we propose what is "difficult to treat PsA", discuss differential diagnosis, commonly overlooked factors, co-morbidities that affect treatment responses, and suggest a stepwise algorithm to manage these patients.
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Affiliation(s)
- Anand Kumthekar
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA.
| | - Maedeh Ashrafi
- Department of Medicine, Jacobi Medical Center / Albert Einstein College of Medicine, New York, NY, USA
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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21
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Reich A, Weiß A, Lindner L, Baraliakos X, Poddubnyy D, Zinke S, Stille C, Strangfeld A, Regierer AC. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: an analysis from the RABBIT-SpA cohort. Arthritis Res Ther 2023; 25:136. [PMID: 37533077 PMCID: PMC10394807 DOI: 10.1186/s13075-023-03127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA), concomitant depression might have a negative impact on the course of disease and treatment outcomes. The aims of this analysis are to determine the prevalence of depressive symptoms in axSpA and PsA patients in a real-world cohort study and to identify sociodemographic and clinical associated factors for moderate or severe depressive symptoms in both diseases. METHODS Patients from the RABBIT-SpA cohort with an axSpA or PsA diagnosis and a valid WHO-5 Well-Being Index score at baseline were included. A descriptive analysis of baseline and outcome parameters by category of depressive symptoms was performed and factors associated with the presence of depressive symptoms (moderate or severe) were examined in a logistic regression. RESULTS Two thousand four hundred seventy patients (1,245 axSpA; 1,225 PsA) were included in the analysis. In both diagnoses, the proportion of patients with moderate depressive symptoms was 8% and 21% with severe symptoms. Patients with moderate or severe depressive symptoms were less likely to engage in sports than those with no or mild depressive symptoms, had more comorbidities and higher scores for disease activity, functional limitations, fatigue, and pain and took more analgesics. In axSpA, patients with a higher disease activity, a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms, while patients with more years in education and engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. PsA patients with a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms while those engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. CONCLUSION We confirmed a high prevalence of depressive symptoms in both PsA and axSpA. Factors negatively associated with the presence of depressive symptoms were fatigue, not engaging in sports, and greater functional limitations. Depressive symptoms may affect the perception of disease activity / severity by patients. Thus, depressive symptoms are an important condition in axSpA and PsA that should be considered when evaluating disease activity and treatment outcomes.
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Affiliation(s)
- Andreas Reich
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Anja Weiß
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Lisa Lindner
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Xenofon Baraliakos
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Denis Poddubnyy
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Gastroenterology, Infectiology and Rheumatology, Berlin, Germany
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anne C. Regierer
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
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22
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McGagh D, McGowan N, Hinds C, Saunders KEA, Coates LC. Actigraphy-derived physical activity levels and circadian rhythm parameters in patients with psoriatic arthritis: relationship with disease activity, mood, age and BMI. Ther Adv Musculoskelet Dis 2023; 15:1759720X231174989. [PMID: 37435529 PMCID: PMC10331082 DOI: 10.1177/1759720x231174989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 07/13/2023] Open
Abstract
Background Psoriatic arthritis (PsA) is associated with sleep disturbance, depression and a lifetime risk of obesity and cardiovascular disease. To date, there have been no studies investigating the relationship between objectively-measured physical activity (PA) levels and circadian rhythm disturbance with disease activity, daily symptoms and mood in patients with PsA. Objective This pilot study aimed to investigate the relationship between disease activity, daily symptoms and mood on PA and circadian rhythm in PsA. Design A prospective cohort study recruiting adults with PsA from rheumatology clinics at a single centre in the UK. Methods Participants wore an actigraph and recorded their symptoms and mood on a daily basis via a smartphone app for 28 days. Time spent in sedentary, light and moderate-to-vigorous physical activity (MVPA) and parameters reflecting the circadian rhythm of the rest-activity pattern were derived. This included the onset time of the least active 5-h (L5) and most active 10-h (M10) daily consecutive periods and the relative amplitude (RA). The relationship factors between baseline clinical status, daily symptoms, PA and circadian measures were examined using linear mixed effect regression models. Results Nineteen participants (8/19 female) were included. Participants with active PsA spent 63.87 min (95% CI: 18.5-109.3, p = 0.008) more in inactivity and 30.78 min (95% CI: 0.4-61.1, p = 0.047) less in MVPA per day compared to those in minimal disease activity (MDA). Age, body mass index and disease duration were also associated with PA duration. Participants with worse functional impairment had an M10 onset time 1.94 h (95% CI: 0.05-3.39, p = 0.011) later than those with no reported functional impairment. No differences were detected for L5 onset time or RA. Higher scores for positive mood components such as feeling energetic, cheerful and elated were associated with less time in inactivity and greater time spent in MVPA overall. Conclusion Our study highlights differences in PA and circadian rest-activity pattern timing based on disease activity, disability and daily mood in PsA. Reduced PA levels in patients with active disease may contribute to the observed increased risk of cardiovascular and metabolic sequelae, with further studies exploring this need.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar
Research Centre, Old Road, Headington, Oxford, OX3 7LD, UK
| | - Niall McGowan
- Sleep and Circadian Neuroscience Institute,
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford,
Oxfordshire, UK
- Department of Psychiatry, University of Oxford,
Oxford, UK
| | - Chris Hinds
- Oxford Digital Phenotyping Laboratory, Big Data
Institute, University of Oxford, Oxford, UK
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford,
Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford
Hospital, Oxford, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
UK
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23
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Dutt S, Roul P, Yang Y, Johnson TM, Michaud K, Sauer B, Cannon GW, Baker JF, Curtis JR, Mikuls TR, England BR. Multimorbidity Patterns and Rheumatoid Arthritis Disease Outcomes: Findings From a Multicenter, Prospective Cohort. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25184. [PMID: 37394710 PMCID: PMC10758525 DOI: 10.1002/acr.25184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To determine whether unique multimorbidity patterns are associated with long-term rheumatoid arthritis (RA) disease severity. METHODS We conducted a cohort study within the Veterans Affairs Rheumatoid Arthritis registry. We applied previously derived multimorbidity patterns based on the presence of diagnostic codes for relevant conditions prior to enrollment using linked administrative data. Disease activity and functional status were assessed longitudinally up to 5 years after enrollment. The association of multimorbidity patterns with disease activity and functional status were assessed using generalized estimating equations models adjusting for relevant confounders. RESULTS We studied 2,956 participants, of which 88.2% were male, 76.9% reported white race, and 79.3% had a smoking history. Mental health and substance abuse (β 0.12 [95% confidence interval {CI} 0.00, 0.23]), cardiovascular (β 0.25 [95% CI 0.12, 0.38]), and chronic pain (β 0.21 [95% CI 0.11, 0.31]) multimorbidity were associated with higher Disease Activity Score in 28 joints (DAS28) scores. Mental health and substance abuse (β 0.09 [0.03, 0.15]), cardiovascular (β 0.11 [95% CI 0.04, 0.17]), and chronic pain multimorbidity (β 0.15 [95% CI 0.10, 0.20]) were also associated with higher Multidimensional Health Assessment Questionnaire (MDHAQ) scores. The metabolic pattern of multimorbidity was not associated with DAS28 or MDHAQ. The number of multimorbidity patterns present was highly associated with DAS28 and MDHAQ (P trend < 0.001), and patients with all four multimorbidity patterns had the highest DAS28 (β 0.59 [95% CI 0.36, 0.83]) and MDHAQ (β 0.27 [95% CI 0.16, 0.39]) scores. CONCLUSION Mental health and substance abuse, chronic pain, and cardiovascular multimorbidity patterns are associated with increased RA disease activity and poorer functional status. Identifying and addressing these multimorbidity patterns may facilitate achieving RA treatment targets.
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Affiliation(s)
- Sarah Dutt
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Tate M. Johnson
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE
- FORWARD, the National Data Bank for Rheumatic Disease, Wichita, KS
| | - Brian Sauer
- VA Salt Lake City & University of Utah, Salt Lake City, UT
| | | | - Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center & University of Pennsylvania, Philadelphia, PA
| | | | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Bryant R. England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
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24
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Queiro R, Loredo M, Braña I, Pardo E, Alonso S, Alperi M. Managing psoriatic arthritis in different clinical scenarios. Expert Rev Clin Immunol 2023; 19:1469-1484. [PMID: 37589128 DOI: 10.1080/1744666x.2023.2249235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients' physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging. AREAS COVERED In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes. EXPERT OPINION Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.
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Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo, Spain
- Department of Medicine, Oviedo University School of Medicine, Oviedo, Spain
| | - Marta Loredo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Ignacio Braña
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Sara Alonso
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
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25
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Upadhyaya SK, Malgutte DR, Handa R, Gupta S, Kumar A, Budumuru S. Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic. BMJ Open 2023; 13:e069014. [PMID: 37321814 PMCID: PMC10276963 DOI: 10.1136/bmjopen-2022-069014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This study evaluated the prevalence of fibromyalgia (FM), anxiety and depression in patients with rheumatoid arthritis (RA) and their effects on the clinical parameters of RA during the COVID-19 pandemic. DESIGN Cross-sectional, outpatient clinic, observational, non-interventional. SETTING Single-centre, tertiary care, multispecialty, service and research hospital, north-central India. PARTICIPANTS Adult patients with RA, controls. RESULTS This cross-sectional study included 200 patients with RA diagnosed with the American College of Rheumatology/European League Against Rheumatism 2010 (ACR) criteria and 200 controls. FM was diagnosed using the revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in patients with RA were assessed using multiple Disease Activity Scores. The presence of depression and anxiety was determined using the Hospital Anxiety and Depression Scale. FM was present in 31% of patients with RA compared with 4% of controls in our study. Patients with RA with FM were older, predominantly females with longer disease duration, and more likely to be on steroids. Patients with RA with FM had a higher disease activity, and none of our RA with FM patients were in remission. The multivariable analysis found FM to be an independent predictor of the Simplified Disease Activity Index for RA. Patients with RA with FM had worse functional ability and poorer quality of life. The prevalence of anxiety and depression was 12.5% and 30%, significantly higher in RA with FM patients. CONCLUSION During the COVID-19 pandemic, around one-third of our study patients had FM and depression, significantly higher than pre-COVID-19 times. Thus, mental health assessment should be incorporated into the routine management of patients with RA.
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Affiliation(s)
| | | | - Rohini Handa
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sirinder Gupta
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil Kumar
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
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26
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Taylor PC. Pain in the joints and beyond; the challenge of rheumatoid arthritis. THE LANCET. RHEUMATOLOGY 2023; 5:e351-e360. [PMID: 38251602 DOI: 10.1016/s2665-9913(23)00094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 01/23/2024]
Abstract
Pain is a common and often debilitating symptom for people living with rheumatoid arthritis. Although pain is a generic feature of inflammation and often improves with successful treatment that targets inflammatory pathways, pain experience can persist. Emerging data suggest that the magnitude of pain relief might vary according to the therapeutic target of pharmacological intervention within the inflammatory cascade. Both inflammatory and non-inflammatory causes contribute to the pain experience, which depends on tissue origin, peripheral sensory mechanisms and their transmission, integration, and interpretation within the nervous system. Contemporary neuroimaging is transforming our understanding of these mechanisms and the role of sensory, emotional, and cognitive contributions to the experience of pain. This understanding paves the way for therapeutic approaches that recognise the existence of multiple, cognitively driven, supraspinal mechanisms for pain modulation and could complement pharmacological inflammation suppression. Such approaches include neuropsychological interventions that have the potential to modify human brain cortical structure and reduce suffering that is often associated with pain experience.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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27
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Wilk M, Pripp AH, Korkosz M, Haugeberg G. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 2023; 43:687-694. [PMID: 36624289 DOI: 10.1007/s00296-023-05271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland.
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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28
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Meléndez-Monreal KC, Brambila-Tapia AJL, González-Díaz V, Cerpa-Cruz S, Gutiérrez-Ureña SR, Yeo-Ayala MDC, Robles-García R, Martínez-Bonilla GE. Association of positive psychological variables with disease activity, functional disability and erythrocyte sedimentation rate in patients with rheumatoid arthritis: a preliminary study. Reumatismo 2023; 74. [PMID: 36942982 DOI: 10.4081/reumatismo.2022.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/20/2022] [Indexed: 03/23/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease which has shown positive correlations between negative psychological variables and disease activity in transversal studies and in the follow-up. However, the association of positive psychological variables with disease parameters including disease activity (DAS-28), functional disability (HAQ) and erythrocyte sedimentation rate (ESR) has not been investigated. Patients with RA attending the external consultation of a third level hospital were invited to participate and fill in a questionnaire with personal, disease and psychological variables; body mass index was also obtained as well as ESR. A total of 49 patients were included. The three dependent variables correlated among them, with the highest correlation for DAS-28 and HAQ (r=0.645, p<0.01), followed by somatization and HAQ (r=0.614, p<0.01) or DAS-28 (r=0.537, P<0.01). In addition, HAQ showed negative correlations with environmental mastery (r=- 0.366, p<0.01), personal growth (r=-0.292, p<0.05) and monthly extra money (r=-0.328, p<0.05), and borderline negative correlations with emotion perception (r=-0.279, p=0.053) and self-acceptance (r=-0.250, p=0.08). ESR showed a significant negative correlation with emotion perception (r=-0.475, p<0.01). In conclusion, we observed important correlations of positive psychological variables with disease activity, functional disability and ESR that could be addressed in order to prevent or treat these disease features.
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Affiliation(s)
- K C Meléndez-Monreal
- Maestría en Psicología de la Salud, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadaljara, Guadalajara, Jalisco.
| | - A J L Brambila-Tapia
- Departamento de Psicología Básica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadaljara, Guadalajara, Jalisco.
| | - V González-Díaz
- Servicio de Reumatología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco.
| | - S Cerpa-Cruz
- Servicio de Reumatología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco.
| | - S R Gutiérrez-Ureña
- Servicio de Reumatología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco.
| | - M D C Yeo-Ayala
- Departamento de Psicología Básica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadaljara, Guadalajara, Jalisco.
| | - R Robles-García
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México.
| | - G E Martínez-Bonilla
- Servicio de Reumatología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco.
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29
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Multi-modality data-driven analysis of diagnosis and treatment of psoriatic arthritis. NPJ Digit Med 2023; 6:13. [PMID: 36732611 PMCID: PMC9895430 DOI: 10.1038/s41746-023-00757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Psoriatic arthritis (PsA) is associated with psoriasis, featured by its irreversible joint symptoms. Despite the significant impact on the healthcare system, it is still challenging to leverage machine learning or statistical models to predict PsA and its progression, or analyze drug efficacy. With 3961 patients' clinical records, we developed a machine learning model for PsA diagnosis and analysis of PsA progression risk, respectively. Furthermore, general additive models (GAMs) and the Kaplan-Meier (KM) method were applied to analyze the efficacy of various drugs on psoriasis treatment and inhibiting PsA progression. The independent experiment on the PsA prediction model demonstrates outstanding prediction performance with an AUC score of 0.87 and an AUPR score of 0.89, and the Jackknife validation test on the PsA progression prediction model also suggests the superior performance with an AUC score of 0.80 and an AUPR score of 0.83, respectively. We also identified that interleukin-17 inhibitors were the more effective drug for severe psoriasis compared to other drugs, and methotrexate had a lower effect in inhibiting PsA progression. The results demonstrate that machine learning and statistical approaches enable accurate early prediction of PsA and its progression, and analysis of drug efficacy.
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30
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Panagiotopoulos A, Fragoulis GE. Comorbidities in Psoriatic Arthritis: A Narrative Review. Clin Ther 2023; 45:177-189. [PMID: 36737317 DOI: 10.1016/j.clinthera.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a common type of inflammatory arthritis. Patients with PsA present with certain extra-articular manifestations and comorbidities (often collectively called psoriatic disease). The purpose of the present review was to highlight the main comorbidities in the setting of PsA. METHODS A narrative review was performed using data from articles found in a search of PubMed and Scopus using the terms psoriatic arthritis and comorbidities. FINDINGS Cardiovascular disease (CVD), as well as metabolic and mental health disorders, are the most common comorbidities in patients with PsA. In most cases, underlying inflammation seems to be involved in the increased risk for CVD in PsA, while a bidirectional relationship seems to operate between mental health disorders and psoriatic disease. The treatment of patients with PsA, especially with biologic disease-modifying antirheumatic drugs, has been shown to lead to favorable outcomes regarding the CVD risk. However, it is debatable whether specific drug classes are more effective than others or should be avoided in patients with CVD risk factors. Comorbidity of mental health disorders is even more complex, given the difficulties in measuring and reporting these comorbidities in clinical trials and in clinical practice. IMPLICATIONS Future studies are needed for a better understanding of the pathogenic mechanisms of, and the development of better protocols for the identification and treatment of patients with, comorbidities in patients with PsA. The education of clinicians, health care professionals in rheumatology, and patients could be useful in achieving this goal.
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Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
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Moudi S, Heidari B, Yousefghahari B, Gholami R, Gholinia H, Babaei M. The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis. Reumatologia 2023; 61:86-91. [PMID: 37223374 PMCID: PMC10201383 DOI: 10.5114/reum/154905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. MATERIAL AND METHODS Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. RESULTS Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. CONCLUSIONS These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.
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Affiliation(s)
- Sousan Moudi
- Health Research Center, Master of Biostatistics and Epidemiology, Babol University of Medical Science, Iran
| | - Behzad Heidari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Behnaz Yousefghahari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Reza Gholami
- Student Research Committee, Babol University of Medical Sciences, Iran
| | - Hemmat Gholinia
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Mansour Babaei
- Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Iran
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Alharbi S. Depression in Saudi Patients with Rheumatoid Arthritis. Open Access Rheumatol 2023; 15:1-9. [PMID: 36726480 PMCID: PMC9885770 DOI: 10.2147/oarrr.s397489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
Purpose Depression is the most common psychiatric disorder associated with rheumatoid arthritis (RA). However, little is known about its prevalence and risk factors among Saudi patients, specifically. Therefore, this study sought to determine the prevalence and predictors of depression in patients with RA in Saudi Arabia. Patients and Methods A cross-sectional study was conducted with patients registered at the Saudi Charitable Association for Rheumatic Diseases. Inclusion criteria were that the patients either met the American College of Rheumatology 1987 revised criteria for the classification of RA or the 2010 RA classification criteria. Demographic data and clinical variables were collected, and Beck's 21-item Depression Inventory was used to assess for depression. Results Of the 210 participants with RA, 171 were women (81.4%), and 39 were men (18.6%). The prevalence of depression was 68%. There were significant relationships between age, gender, marital status, and having depression. Rheumatoid factor (RF) was positive in 144 participants (68.6%), which positively correlated with the risk of having depression (P value < 0.001). Moreover, depression severity correlated with age, gender, marital status, RF positivity, and prolonged disease duration. Conclusion Based on the results, depression is highly prevalent in Saudi patients with RA, especially those with positive RF and those who are female, middle-aged, and divorced. Early detection and treatment of depression in patients with RA is highly recommended to improve their quality of life and avoid unfavorable effects on RA clinical progression.
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Affiliation(s)
- Samar Alharbi
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia,Correspondence: Samar Alharbi, Department of Medicine, Taibah University, Medina, 42312-3779, Saudi Arabia, Tel +96 6553018777, Fax +96 648461172, Email
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Liu N, Yan W, Su R, Zhang L, Wang X, Li Z, Qin D, Peng J. Research progress on rheumatoid arthritis-associated depression. Front Behav Neurosci 2023; 16:992223. [PMID: 36755665 PMCID: PMC9899853 DOI: 10.3389/fnbeh.2022.992223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
Abstract
Depression is an independent mood disorder and one of the most common comorbidities of rheumatoid arthritis (RA). Growing evidence suggests that there is two-way regulation between RA and depression, resulting in a vicious cycle of RA, depression, poor outcomes, and disease burden. The rising prevalence of RA-associated depression warrants a re-examination of the relationships between them. Here we provide an overview of the etiology and pathological mechanisms of RA-associated depression, and recent advances in treatment with biologics, which will facilitate the development of new and effective prevention and treatment strategies.
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Affiliation(s)
- Nian Liu
- First Clinical Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Weitian Yan
- First Clinical Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Rong Su
- Rheumatism Center, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
| | - Lin Zhang
- First Clinical Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Xingqiang Wang
- Rheumatism Center, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
| | - Zhaofu Li
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, China,*Correspondence: Zhaofu Li Dongdong Qin Jiangyun Peng
| | - Dongdong Qin
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, China,*Correspondence: Zhaofu Li Dongdong Qin Jiangyun Peng
| | - Jiangyun Peng
- Rheumatism Center, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China,*Correspondence: Zhaofu Li Dongdong Qin Jiangyun Peng
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Plank PM, Hinze CA, Campbell V, Konwert S, Welte T, Drick N, Kayser MZ, Suhling H, Fuge J. Relationship Between the Response to Antibody Therapy and Symptoms of Depression and Anxiety Disorders in Patients with Severe Asthma. J Asthma Allergy 2023; 16:421-431. [PMID: 37096014 PMCID: PMC10122462 DOI: 10.2147/jaa.s403296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose Asthma is associated with a high prevalence of psychopathological disorders, especially depressive disorders or anxiety. In patients with uncontrolled severe asthma, monoclonal antibody (mAb)-therapy positively influenced control of mental disorders. Therefore, we evaluated the impact of antibody therapy on the burden of these mental diseases depending on responder status. Patients and Methods Data were collected retrospectively in patients with uncontrolled severe asthma (n = 82) prior to mAb-therapy ("baseline") (omalizumab, dupilumab, benralizumab or mepolizumab). Symptoms of Major Depressive Disorder (MDD) or General Anxiety Disorder (GAD) were detected at baseline using the Hospital Anxiety and Depression Scale (HADS), as well as general sociodemographic data and lung function parameters. At 6-month (±3 month) follow-up, the burden of psychopathological symptoms under mAb-therapy was assessed using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder Scale-2 (GAD-2). Response status was classified using the Biologics Asthma Response Score (BARS), assessing exacerbations, oral corticosteroid usage and asthma control test (ACT) score. Predictors for non-response to mAb-therapy were identified using linear regression analysis. Results Patients with severe asthma suffered from symptoms of MDD/GAD more often compared to the general population, with a higher prevalence among mAb therapy non-responders. mAb-responders exhibited a declining burden of MDD, better quality of life (QoL), less exacerbations, better lung function and better disease control compared to non-responders. A history of symptoms of depression was identified as a predictor for non-response to mAb-therapy. Conclusion Asthma symptoms and psychological problems are linked and more prevalent in our cohort of severe asthma patients than in the general population. Patients with signs of MDD/GAD before mAb-therapy show less mAb therapy response suggesting a negative impact of prior psychological problems on treatment response. In some patients, the score on MDD/GAD was caused by severe asthma - here symptoms decreased after effective treatment.
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Affiliation(s)
- Pia Maria Plank
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Correspondence: Christopher Alexander Hinze, Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, Tel +49 511-5323531, Email
| | - Victoria Campbell
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Stefanie Konwert
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Nora Drick
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Moritz Z Kayser
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hendrik Suhling
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jan Fuge
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Lada G, Chinoy H, Talbot PS, Warren RB, Kleyn CE. The Relationship of Depression and Systemic Inflammation in Psoriasis: Findings from the UK Biobank. J Invest Dermatol 2022; 143:1091-1094.e2. [PMID: 36566876 DOI: 10.1016/j.jid.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Georgia Lada
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | - C Elise Kleyn
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
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Ionescu CE, Popescu CC, Agache M, Dinache G, Codreanu C. Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1637. [PMID: 36422176 PMCID: PMC9696661 DOI: 10.3390/medicina58111637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 08/08/2023]
Abstract
Depression is one of the most frequent comorbidities in rheumatoid arthritis (RA); it takes an important toll on the quality of life of these patients and also leads to a decrease in life expectancy. The current article is a narrative review on depression in RA, with the objective to emphasize and raise awareness on the high prevalence, pathogenic mechanisms, and effects that depression has on RA patients. In RA, the prevalence of depression has been shown to be 2 to 3 times higher than in the general population, with a meta-analysis reporting that 16.8% of RA patients have a major depressive disorder. Future studies are needed to determine the most accurate self-reported depression questionnaires and their ideal threshold for defining depression as compared to diagnostic interview as gold-standard for patients with RA to allow better comparisons across studies. The pathogenesis of depression remains to be fully understood, but recent specialty literature suggests that immune-mediated processes are involved and that there are similarities between the neural networks recruited in inflammation and those implicated in the pathophysiology of depression. Depression in patients with RA is associated with poor long-term outcomes. Multiple studies have shown that depression in RA is associated with increased pain, fatigue, and physical disability. It alters treatment compliance, causes more comorbidities, and leads to higher mortality, partly through increased suicide risk. Depression in RA also increases health service utilization and healthcare costs directly through hospitalization, but also indirectly through loss of work productivity. Assessing depression could be a significant psychomarker of rheumatological outcome in RA.
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Affiliation(s)
- Cătălina-Elena Ionescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Claudiu Costinel Popescu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Mihaela Agache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Georgiana Dinache
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
| | - Cătălin Codreanu
- Rheumatology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Ion Stoia” Clinical Center of Rheumatic Diseases, 020983 Bucharest, Romania
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Novella-Navarro M, Balsa A. Difficult-to-Treat Rheumatoid Arthritis in Older Adults: Implications of Ageing for Managing Patients. Drugs Aging 2022; 39:841-849. [PMID: 36104655 PMCID: PMC9626415 DOI: 10.1007/s40266-022-00976-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Difficult-to-treat rheumatoid arthritis is a heterogeneous term in which patients may present with difficulties in their management for different reasons. This can ultimately lead to patients being exposed to multiple treatments because of inefficacy (resulting from mechanisms intrinsic to rheumatoid arthritis or from non-inflammatory causes such as chronic pain syndrome or structural damage, among others), toxicity or adverse effects that may be linked to comorbidities. One particular group in which such characteristics may be more patent is older patients. Increasing life expectancy, an ageing population and the late onset of rheumatoid arthritis have led to an increased interest in the particularities of treating older patients. This may pose a challenge for physicians, as ageing has implications for optimal patient treatment owing to the potential presence of comorbidities, the risk of adverse events and perceptions of disease status by both physicians and patients. All of these factors may have implications for classifying and managing patients aged > 65 years as difficult-to-treat rheumatoid arthritis, as these patients could be misclassified. This can occur when a significant proportion may still exhibit signs of active disease but not necessarily be difficult to treat because the treatment criterion has not been fulfilled. Alternatively, patients may be exposed to multiple biologic/targeted disease-modifying antirheumatic drugs because of contraindications and/or comorbid conditions. Treatment-to-target strategies and an adequate assessment of inflammatory rheumatoid arthritis activity in older patients should be undertaken, taking special care with associated comorbidities, polypharmacy and risk profiles. Such an approach can help to ensure appropriate treatment for older adults and avoid the misclassification of difficult-to-treat patients.
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Affiliation(s)
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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Gialouri CG, Evangelatos G, Pappa M, Karamanakos A, Iliopoulos A, Tektonidou MG, Sfikakis PP, Fragoulis GE. Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice. Ther Adv Musculoskelet Dis 2022; 14:1759720X221122417. [PMID: 36081746 PMCID: PMC9445451 DOI: 10.1177/1759720x221122417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/03/2022] [Indexed: 01/01/2023] Open
Abstract
Background: The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable. Objectives: To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease. Design: In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including composite disease activity indices [clinical Disease Activity in PSoriatic Arthritis (cDAPSA) and minimal disease activity (MDA)] and patient-reported outcomes (PROs). Agreement between CRP status and cDAPSA/MDA scores was calculated (Cohen’s kappa). Methods: Data from consecutive PsA patients attending two outpatient rheumatology clinics (January 2019–June 2021) were analysed. Results: From 128 patients enrolled (51.6% females; mean ± standard deviation age: 53.4 ± 11.7 years; 23.4%, 48.4% and 64.1% treated with glucocorticoids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs, respectively), two-thirds (66.4%, n = 85) had normal CRP values. CRP status was not associated with any of the disease-related parameters and PROs, but only with ESR [odds ratio: 1.04 (95% confidence interval: 1.01–1.06), p = 0.005]. Among patients with normal CRP, 45.9% (39/85) were on non-MDA state, while 21.2% (18/85) had cDAPSA-moderate and 5.9% (5/85) had cDAPSA-high disease activities. Conversely, 54.2% (39/72) of patients on non-MDA state and 52.3% (23/44) of those with cDAPSA-moderate or cDAPSA-high disease activity had normal CRP values. Cohen’s kappa between normal CRP and MDA, cDAPSA-remission, and cDAPSA-remission/low disease activity was –0.26, –0.21 and –0.22, respectively, displaying total disagreement. Conclusion: Normal CRP in PsA should not be used as surrogate marker of remission or low/MDA, therefore needs to be interpreted with caution in clinical decision-making.
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Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Shared Fund Hospital NIMTS, Athens, Greece
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75 Str, Athens 11527, Greece
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Manning-Bennett AT, Hopkins AM, Sorich MJ, Proudman SM, Foster DJR, Abuhelwa AY, Wiese MD. The association of depression and anxiety with treatment outcomes in patients with rheumatoid arthritis - a pooled analysis of five randomised controlled trials. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111613. [PMID: 35898566 PMCID: PMC9310212 DOI: 10.1177/1759720x221111613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune condition associated
with an increased risk of developing depression and anxiety. Depression and
anxiety are associated with worse outcomes in RA, but the magnitude of the
effect of each condition on RA outcomes is unclear. It is also unknown how
pharmacological treatment of depression affects RA outcomes. Objective: The primary aim of this study was to investigate the association of comorbid
depression and anxiety with remission in patients with RA. Secondary aims
were to determine the association between comorbid depression and anxiety on
patient-reported outcomes and the relationship between concomitant use of
antidepressants and remission in patients with depression. Design: Data from patients with moderate to severe RA were pooled from five
randomised controlled trials investigating tocilizumab and conventional
synthetic disease-modifying agents. Methods: Remission was defined as a clinical disease activity index (CDAI) of ⩽2.8 and
simple disease activity index (SDAI) of ⩽3.3. The association between the
time to reach remission and depression and anxiety was analysed using Cox
proportional hazard analysis. Results: Individual patient data were available from 5502 subjects, of whom 511 had
depression, 236 had anxiety and 387 were using antidepressants. Depression
was significantly associated with reduced remission [adjusted HR (95% CI):
0.62 (0.48–0.80), p < 0.001 and adjusted HR (95% CI):
0.59 (0.44–0.79), p < 0.001] using CDAI and SDAI,
respectively. Depression was associated with a lower likelihood of achieving
more subjective outcomes (⩽1 physician global assessment, ⩽1 patient global
assessment) and ⩽1 28-swollen joint count, but not ⩽1 28-tender joint count
or C-reactive protein measurement. Treatment with antidepressants did not
improve outcomes for patients with depression. Anxiety was not significantly
associated with RA remission. Conclusion: Comorbid depression, but not anxiety, was associated with less frequent
remission. Concomitant antidepressant use was not associated with
improvements in RA outcomes in patients with depression.
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Affiliation(s)
- Arkady T Manning-Bennett
- UniSA: Clinical & Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Ashley M Hopkins
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - David J R Foster
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ahmad Y Abuhelwa
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael D Wiese
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
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Michelsen B, Berget KT, Loge JH, Kavanaugh A, Haugeberg G. Sex difference in disease burden of inflammatory arthritis patients treated with tumor necrosis factor inhibitors as part of standard care. PLoS One 2022; 17:e0266816. [PMID: 35511905 PMCID: PMC9071161 DOI: 10.1371/journal.pone.0266816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Knowledge is needed on the total disease burden across the sexes in inflammatory arthritis (IA). We aimed to compare disease burden, including a broad range of health aspects, across men and women with IA treated with tumor necrosis factor inhibitors (TNFi). Methods Adult outpatients with IA (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis) were included as part of standard care. Patient-reported outcomes, disease activity, TNFi trough levels, calprotectin, Work Productivity and Activity Impairment, comorbidities and cardiovascular risk profile were assessed. Unadjusted comparisons across sexes were done with independent t-test, Mann-Whitney U-test and X2-test and adjusted analyses with General Linear Models and logistic/ordinal logistic regression. Results A total of 305 IA patients were included (167 men, 138 women). A significantly lower proportion of women (45%) than men (59%) were in remission according to disease-specific composite scores (p = 0.02). Women had significantly worse scores on pain, joint pain, fatigue, enthesitis, Health Assessment Questionnaire and Short Form (SF)-36 vitality and social functioning (all p≤0.04). Both sexes had worse SF-36 scale scores than the general population. Women reported more absenteeism (work time missed) and activity impairment. TNFi trough levels, neutralizing antibodies and calprotectin were similar across sexes. A similar total number of comorbidities was seen. Self-reported hypothyroidism was more frequent in women. Men had higher 10-year calculated risk of fatal cardiovascular events. Conclusion Important differences in disease burden between men and women were seen. More attention to sex differences in the follow-up of IA patients is warranted.
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Affiliation(s)
- Brigitte Michelsen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
- * E-mail:
| | - Kristine Thomassen Berget
- Department of Clinical Immunology and Transfusion Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | | | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, United States of America
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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De Cock D, Doumen M, Vervloesem C, Van Breda A, Bertrand D, Pazmino S, Westhovens R, Verschueren P. Psychological stress in rheumatoid arthritis: a systematic scoping review. Semin Arthritis Rheum 2022; 55:152014. [PMID: 35489168 DOI: 10.1016/j.semarthrit.2022.152014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 04/18/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) considerably impacts patients' mental health. However, it is largely unclear how people suffering from RA experience psychological stress beyond depression or anxiety, and what drives stress in these patients. OBJECTIVE To examine the impact of RA on psychological stress, as follows: 1) How is stress defined and described in studies on RA? 2) Do patients with RA experience more stress than the general population or people suffering from other chronic conditions? 3) What are risk factors for developing stress in this context? METHODS We systematically searched EMBASE, PubMed, Web of Science Core Collection and Cochrane Library for English language peer-reviewed reports published up to 19 April 2020. Eligible studies included any measure or definition of psychological stress as an outcome in patients with RA. Data were extracted on patient and study characteristics, instruments used to measure stress and predictors of stress, and were summarized descriptively. Study quality was assessed with the MINORS or AXIS-tool for longitudinal and cross-sectional studies, respectively. RESULTS Among 11.115 potentially relevant studies, 16 studies were included. Remarkably, 13 different instruments to measure stress were reported in these studies. Different types of stress experienced by patients with RA included role stress, social stress, and work stress. Work stress and social stress, particularly resulting from interpersonal stressors, were reported as more prevalent in patients with RA compared to healthy controls. Stress at disease onset appeared more pronounced in patients with RA compared to people suffering from osteoarthritis, while psychological stress was reported as higher in patients with chronic pain syndromes compared to patients with RA. More disability, more pain, less social support, lower income, younger age and personality traits like excessive worrying, pessimism, and sensitivity to anxiety, seemed to increase the risk for higher stress levels. CONCLUSIONS This scoping review is, to our knowledge, the first to address the important heterogeneity of the measurement tools and definitions of psychological stress in RA research. This review could provide a basis to standardize the concept of stress in people suffering from RA, with a view to proposing tailored stress-reducing interventions.
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Affiliation(s)
- Diederik De Cock
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Michaël Doumen
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
| | | | - Annelies Van Breda
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Sofia Pazmino
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - René Westhovens
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium; Rheumatology, University Hospitals Leuven, Leuven, Belgium
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Kiltz U, Wiatr T, Redeker I, Baraliakos X, Fedorov K, Braun J. Effects of patient and disease characteristics on global functioning in patients with axial spondyloarthritis in routine care. Semin Arthritis Rheum 2022; 55:152006. [DOI: 10.1016/j.semarthrit.2022.152006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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Liu Z, Li M, Ren C, Zhu G, Zhao X. Relationship Between Physical Activity, Parental Psychological Control, Basic Psychological Needs, Anxiety, and Mental Health in Chinese Engineering College Students During the COVID-19 Pandemic. Front Psychol 2022; 13:802477. [PMID: 35350737 PMCID: PMC8958037 DOI: 10.3389/fpsyg.2022.802477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
The issue of mental health among college students is of increasing concern during the COVID-19 outbreak. Since course characteristics of engineering college students determine the particularities of their mental health, the specific objectives of this study were: (1) to analyze the relationship between physical activity, parental psychological control, basic psychological needs, anxiety, and mental health in Chinese engineering college students during COVID-19 pandemic; and (2) to examine the mediation effect of anxiety between the relationship of basic psychological needs and mental health. A cross-sectional study was conducted among several universities in Shandong Province, China. We randomly selected 254 Chinese engineering college students from these colleges. Participants who were given questionnaires completed the Physical Activity Rating Scale (PARS-3), Basic Needs Satisfaction in General Scale (BNSG-S), Parental psychological control Questionnaire, the Beck anxiety inventory (BAI), and the Kessler 10 (K10) scale. The mediation model was conducted to assess the mediation effect of anxiety between the relationship of basic psychological needs and mental health. Among 254 Chinese college students majoring in engineering, the results showed that their mental health was in the mid-level range. Besides, physical activity and basic psychological needs is positively correlated with mental health, respectively, while parental psychological control is not correlated with mental health. Anxiety is negatively associated with mental health. Mediation analysis revealed that anxiety played a mediation role in the relationship between basic psychological needs and mental health. In conclusion, mental health of Chinese engineering college students deserves extensive attention during the COVID-19 pandemic. Proper intervention on physical activity, basic psychological needs, and anxiety may be beneficial to improve their mental health. In addition, meeting basic psychological needs is beneficial to reduce anxiety and improve mental health further.
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Affiliation(s)
- Zongyu Liu
- School of Physical Education, Shandong University, Jinan, China
| | - Meiran Li
- School of Physical Education, Shandong University, Jinan, China
| | - Chuanqi Ren
- School of Physical Education, Shandong University, Jinan, China
| | - Guangyu Zhu
- School of Physical Education, Shandong University, Jinan, China
| | - Xiuhan Zhao
- School of Physical Education, Shandong University, Jinan, China
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Hackett S, Ogdie A, Coates LC. Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221086710. [PMID: 35368374 PMCID: PMC8966104 DOI: 10.1177/1759720x221086710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 01/21/2023] Open
Abstract
Psoriatic arthritis (PsA) is a form of chronic inflammatory arthritis associated with psoriasis and a multitude of other symptoms, most commonly arthritis, dactylitis, enthesitis and axial involvement. PsA is significantly heterogeneous, with a highly variable clinical course of PsA. Patients may experience significant or mild skin and joint symptoms, with some patients developing rapidly progressing joint destruction and skin symptoms. Despite the range of symptom severity, PsA is frequently associated with significantly impaired quality of life from joint destruction, as well as chronic pain and a range of comorbidities such as depression and cardiovascular disease. Currently, there are no definitive diagnostic tests for PsA, with diagnosis remaining challenging owing to the heterogeneous presentation and course of the disease. Presently, the CASPAR criteria are often used to aid rheumatologists in distinguishing PsA from other inflammatory arthritides. Treatment options for patients have been expanded over the last two decades with the emerging clinical utility of biological therapies. However, early identification and diagnosis of patients and effective disease control remain unmet medical needs within the PsA community. In addition, predicting response to treatment also remains a challenge to rheumatologists. This review highlights the current hurdles faced by healthcare professionals in the diagnosis and management of PsA patients and provides future action points for consideration by the members of the multidisciplinary team who treat PsA patients.
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Affiliation(s)
- Simon Hackett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexis Ogdie
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
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Dey M, Nagy G, Nikiphorou E. Comorbidities or extra-articular manifestations - time to reconsider the terminology? Rheumatology (Oxford) 2022; 61:3881-3883. [PMID: 35244149 DOI: 10.1093/rheumatology/keac134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK.,Department of Rheumatology, Countess of Chester Hospital NHS Foundation Trust, Liverpool Road, Chester, CH2 1UL, UK
| | - Gyorgy Nagy
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad tér 4, H-1089, Budapest, Hungary.,Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
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Gialouri CG, Evangelatos G, Fragoulis GE. Choosing the Appropriate Target for the Treatment of Psoriatic Arthritis: TNFα, IL-17, IL-23 or JAK Inhibitors? Mediterr J Rheumatol 2022; 33:150-161. [PMID: 36127928 PMCID: PMC9450184 DOI: 10.31138/mjr.33.1.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
Psoriatic arthritis (PsA) is a highly heterogenous disease. Apart from arthritis and psoriasis, other manifestations can also occur, including enthesitis, dactylitis, axial-, nail-, eye- and bowel- involvement. Comorbidities are also frequent in the setting of PsA, with cardiovascular disease and mental-health disorders being the most frequent. The Rheumatologist's arsenal has many different treatment options for treating PsA. Despite their effectiveness, there are some differences in terms of efficacy and safety that might affect clinician's decision for one or the other drug. Comparing biologic DMARDs and JAK-inhibitors, one could say that they have similar effectiveness in terms of musculoskeletal manifestations. However, anti-IL-17 and anti-IL-23 drugs seem to be more effective for skin manifestations. In contrast, JAK-inhibitors and etanercept might be less effective for these manifestations. Inflammatory bowel disease and uveitis are non-responsive to etanercept and anti-IL-17 drugs. As regards to comorbidities, data are scarce, but future studies will shed light on possible differential effect of bDMARDs or JAK-inhibitors. Safety is always an important drive for choosing the appropriate treatment. Infections are the most common adverse event of these drugs. Etanercept and anti-IL-17 drugs are safer for patients having latent tuberculosis, while herpes zoster is more common in individuals receiving JAK-inhibitors. Finally, venous thromboembolism risk, should be taken into account when JAK-inhibitors are used. In this review, we comparatively present, as outlined above, the various aspects that could affect the choice of the appropriate bDMARD or JAK-inhibitor for the treatment of a PsA patient.
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Affiliation(s)
- Chrysoula G. Gialouri
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - George E. Fragoulis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
- Corresponding Author: George E. Fragoulis, MD, PhD Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens Laiko General Hospital, Mikras Asias 75 Str, 11527 Athens, Greece, Tel.: +30 210 746 2636, E-mail:
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Wang XA, Duculan R, Mancuso CA. Coping Mechanisms Mitigate Psychological Stress in Patients With Rheumatologic Diseases During the COVID-19 Pandemic. J Clin Rheumatol 2022; 28:e449-e455. [PMID: 34054073 DOI: 10.1097/rhu.0000000000001757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coping with stress is part of self-managing systemic rheumatic diseases. Our objective was to assess stress and coping during the coronavirus disease 2019 (COVID-19) pandemic. METHODS During the pandemic in New York City, patients taking disease-modifying antirheumatic drugs answered open-ended questions about the pandemic's effects on daily life and their rheumatic condition. Themes of stress and coping were discerned from volunteered responses. Patients also completed the standard Generalized Anxiety Disorder (GAD-7) scale/PROMIS Anxiety surveys. Anxiety scores were independent variables in multivariable analyses with stress and coping themes as combined dependent variables. RESULTS Of the 112 patients interviewed (86% women; mean age, 50 years), 72 volunteered COVID-19-related stress on their rheumatic condition, home, work, and finances. Patients volunteering stress were younger, had disease longer, were taking more than 1 medication, had worse GAD-7 scores and a positive anxiety screen, and had worse PROMIS scores that were significantly worse than population norms (all comparisons, p ≤ 0.01; all variables remained associated in multivariable analyses). Fourty-one patients volunteered coping mechanisms including support from others, engaging in activities, and resilience already establish in dealing with rheumatic diseases. Of these, 18 volunteered both coping and stress and 23 volunteered coping and no stress. Patients in the latter (coping-only) group were more likely to be older, taking only 1 medication, and had better GAD-7 and PROMIS scores (all comparisons, p ≤ 0.02). In multivariable analysis, older age (p = 0.02) and lower GAD-7 (p = 0.03) or PROMIS scores (p = 0.03) remained associated. CONCLUSIONS Patients reported stress and coping due to the COVID-19 pandemic. Analyses with standard anxiety measures demonstrated lower anxiety in patients who volunteered coping mechanisms.
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Affiliation(s)
- Xin A Wang
- From the Department of Medicine, Weill Cornell Medical College
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Lai TL, Au CK, Chung HY, Lau CS. Depression in psoriatic arthritis: Related to socio-demographics, comorbid loads or disease activity? Int J Rheum Dis 2022; 25:474-480. [PMID: 35147299 DOI: 10.1111/1756-185x.14298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
AIM Psychological distress commonly occurs in patients with psoriatic arthritis (PsA). The primary objective of this study was to determine the prevalence of depression in PsA. The secondary objective was to explore its associated factors, including socio-demographics, disease activity data and comorbidities. METHODS Patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis were consecutively recruited from local rheumatology clinics. Depression was assessed by a self-administered Chinese-Cantonese version of the Hospital Anxiety and Depression Scale (HADS). RESULTS Two hundred and eight eligible patients with PsA were recruited, with 82 females and 126 males. Depression was found in 62 (29.8%) of them. The univariate model identified these associated factors: (1) Psoriasis Area and Severity Index score; (2) disease activity measurement, that is tender and swollen joint count, erythrocyte sedimentation rate, C-reactive protein, Disease Activity in Psoriatic Arthritis (DAPSA) score, Leeds Enthesitis Index and tender dactylitis count; (3) quality of life measurement, that is Health Assessment Questionnaire - Disability Index (HAQ-DI), pain and general health perception; (4) PsA duration; and (5) body mass index. The final regression model identified DAPSA and HAQ-DI were closely associated with depression, P = .007 and P = .02 respectively. Moderate and strong correlations with HADS score were found with DAPSA (Kendall's tau-b coefficient [τb] = 0.25) and HAQ-DI (τb = 0.4) respectively. No associations with depression were found between age, living and employment status, gender, demographics, inflammatory markers, disease duration, skin involvement and comorbidities, in term of Charlson's Comorbidity Index. CONCLUSION Depression was prevalent among PsA patients and it was closely correlated with disease activity and physical function impairment. Achieving low disease activity and maintaining physical function in patients with PsA may mitigate the psychological burden. The present study also highlighted the unmet needs of strategies to identify this common phenomenon.
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Affiliation(s)
- Tin Lok Lai
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Chi Kit Au
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Ho Yin Chung
- Rheumatology & Clinical Immunology Team, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Chak Sing Lau
- Rheumatology & Clinical Immunology Team, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
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Wilk M, Łosińska K, Pripp AH, Korkosz M, Haugeberg G. Pain catastrophizing in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: biopsychosocial perspective and impact on health-related quality of life. Rheumatol Int 2022; 42:669-682. [DOI: 10.1007/s00296-021-05070-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
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Anxiety levels before biologic initiation and changes with treatment in patients with psoriatic arthritis: HUR-BIO biologic registry results. Clin Rheumatol 2022; 41:1439-1446. [PMID: 35088209 DOI: 10.1007/s10067-021-06012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease related to several comorbidities. Anxiety is an important comorbidity in PsA and the data is scarce. We aimed to understand the rates before biologic agents and change in anxiety with the treatment. METHODS PsA patients from the Hacettepe University biologic database (HUR-BIO) were assessed for the high anxiety level (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). The rate and scores of anxiety were determined before starting biologic agents, at the first visit within 6 months. Changes in anxiety scores were assessed according to favorable treatment responses, and the correlation was evaluated by Spearman correlation analysis. RESULTS From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score both at baseline and first visit within 6 months. Both the frequency of high anxiety level and mean (SD) scores decreased at the first visit [63.9% vs. 41.4%, 4.8 (3.4) vs. 3.2 (3.1) respectively, p < 0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was also a positive correlation between the change in anxiety scores and all parameters tested for treatment response: pain, PGA, BASDAI, HAQ-DI, DAS-28, and also PsAID-12. CONCLUSION Anxiety is a more frequent problem at biologic initiation than rates observed in the general PsA population. The rates show a decreasing trend and correlates with treatment response but is still high within 6 months under treatment. KEY POINTS • As high as 65% of patients had a high anxiety levels before the initiation of bDMARDs. • The disease activity control is essential in reducing anxiety; however, rates are still high within 6 months. • Decreased anxiety scores and rates of the high anxiety level are linked to better outcomes.
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