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Khan AK, Nabi J, Parrey AH, Rath PD, Lone S. Patterns and prevalence of psychiatric morbidity among individuals with rheumatoid arthritis. Reumatologia 2024; 62:115-120. [PMID: 38799777 PMCID: PMC11114128 DOI: 10.5114/reum/186975] [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: 01/26/2024] [Accepted: 04/09/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints, causing inflammation, pain, and potential joint damage. Patients with RA are at high risk of developing psychiatric morbidity; it is important to recognize these psychiatric manifestations. The relationship between psychiatric symptoms and RA is complex and can involve various factors, including the impact of chronic pain, inflammation, medications, and the overall burden of managing a chronic illness.Aim of the study was to systematically investigate and analyze the patterns and prevalence of psychiatric morbidity among individuals diagnosed with RA, with the aim of identifying common mental health conditions, understanding the interplay between RA and psychiatric disorders, and providing valuable insights for improved holistic patient care. Material and methods This was a prospective, observational cross-sectional study conducted over a period of three years in patients with RA. Psychiatric morbidity was assessed using International Classification of Diseases-10 criteria and Mini-Plus by dedicated psychiatrists. The diagnosis of RA was confirmed using the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) diagnostic criteria for RA and the disease activity was calculated by Disease Activity Score with 28-joint count (DAS28) using the calculator from the RheumaHelper application. The data were analyzed using SPSS, version 23.0. Results A total of 1,000 patients with RA were included in this study. Nearly two-thirds of the patients were female (64.8%). The majority of patients belonged to the age group of 41 to 54 years. Total 47.5% of the patients were unemployed, 27.0% were salaried, 19.0% were businessman, while 6.5% of the patients were students. More than half of the patients (53.2%) had moderate disease activity. Major depressive disorder was the most commonly observed comorbidity (41.0%), followed by somatoform disorder (28.5%), and generalized anxiety disorder was found in 13.5%. No psychiatric manifestations were found in 17% of studied individuals. Conclusions Psychiatric morbidity is associated with RA and there is a need for psychiatric services to be made available to these patients.
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Affiliation(s)
- Ajaz Kariem Khan
- Centre for Rheumatic Diseases, Shifa Superspeciality Hospital, Srinagar, India
| | | | | | - Prasan Deep Rath
- Department of Rheumatology, Max Super Speciality Hospital, New Delhi, India
| | - Sanan Lone
- Shifa Superspeciality Hospital, Magarmal Bagh, Srinagar, India
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Zhang Y, Yang S, Fan A, Du J, Gao N, Pan L, Li T. Decreased IL-4 is the risk factor of depression in patients with Takayasu arteritis. Front Med (Lausanne) 2024; 11:1337206. [PMID: 38426163 PMCID: PMC10902065 DOI: 10.3389/fmed.2024.1337206] [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: 11/12/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Depression is a common complication in Takayasu arteritis (TA). Disorders of the immune system play an important role in both diseases. This study aimed to clarify the feature of cytokines in TA patients with depression. Methods In this cross-sectional study, serum cytokines were tested in 40 TA patients and 11 healthy controls using the Bio-Plex Magpix System (Bio-Rad®). The state of depression was measured by the Zung Self-Rating Depression Scale (SDS) in TA patients. Logistic regression analysis was performed to find the risk factors of depression in patients with TA. Results TA patients with depression had higher ESR, hsCRP, NIH, and ITAS.A than patients without depression (16.00 [10.00, 58.50]mm/H vs. 7.50 [4.50, 17.75]mm/H, p = 0.013; 7.60 [2.32, 46.52]mg/L vs. 0.71 [0.32, 4.37]mg/L, p = 0.001; 2.00 [2.00, 3.00] vs. 1.00 [0.00, 2.00], p = 0.007; 7.00 [4.00, 9.50] vs. 1.50 [0.00, 5.75], p = 0.012, respectively). Additionally, the lower age of onset and levels of IL-4, IL-13, eotaxin, and IP-10 were observed in the depressed group compared with the non-depressed (23.50 [19.25, 32.50]pg./ml vs. 37.00 [23.25, 42.50]pg./ml, p = 0.017; 2.80 [2.17, 3.18]pg./ml vs. 3.51 [3.22, 4.66]pg./ml, p < 0.001; 0.66 [0.60, 1.12]pg./ml vs. 1.04 [0.82, 1.25]pg./ml, p = 0.008; 46.48 [37.06, 61.75]pg./ml vs. 69.14 [59.30, 92.80]pg./ml, p = 0.001; 184.50 [138.23, 257.25]pg./ml vs. 322.32 [241.98, 412.60]pg./ml, p = 0.005, respectively). The lower level of IL-4 and age of onset were the independent risk factors for depression in TA patients (OR [95% CI] 0.124 [0.018, 0.827], p = 0.031; 0.870 [0.765, 0.990], p = 0.035, respectively). Conclusion Our data suggested that lower cytokine levels, especially IL-4, might be involved in the development of TA patients with depression. Clinicians can probably use serum IL-4 level testing as a potential indicator of depression in TA.
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Affiliation(s)
- Yaxin Zhang
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shiyu Yang
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Anyuyang Fan
- Department of the National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Na Gao
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taotao Li
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ahmed I, John P, Bhatti A. Association analysis of Vascular Endothelial Growth Factor-A (VEGF-A) polymorphism in rheumatoid arthritis using computational approaches. Sci Rep 2023; 13:21957. [PMID: 38081836 PMCID: PMC10713577 DOI: 10.1038/s41598-023-47780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Rheumatoid arthritis (RA), is marked by joint inflammation leading to pannus formation which results in cartilage destruction promoting bone erosion. The pathological hallmark of RA includes synovial hyperplasia and synovial angiogenesis. Active tissue neovascularization is observed in RA. Vascular endothelial Growth factor A (VEGFA), an endothelial cell-specific proangiogenic molecule is triggered by hypoxic cells and its levels are upregulated in RA. The aim of this study was to investigate functional and pathogenic VEGFA variants and to identify the impact of point mutation in VEGFA's interaction with VEGFR2 and how these polymorphisms affect the susceptibility and severity of RA. We investigated impact of these point mutations on the stability of VEGFA using various computational tools. These mutations were further identified by conservational profile as they are highly involved as structural and functional mutations. Furthermore, these selected variants were modelled and docked against targeted domain regions IGD2 and IGD3 of VEGFR2. Further molecular dynamic simulations were performed using Gromacs. Out of 168 nsSNPS, 19 were highlighted as highly pathogenic using insilico prediction tools. InterPro and ConSurf revealed domains and conserved variants respectively. After stability analysis, we concluded that almost all the mutations were responsible for decreasing the protein stability. HOPE predicted that all the selected damaging nsSNPs were present in the domain which is essential for the functioning of VEGFA protein. Constructed Ramachandran plot and ERRAT validated the quality of all the models. Based on the interactions predicted by STRING database, we performed Protein-Protein docking between VEGFA and VEGFR2. We found few conserved interactions and new polar contacts among wild-type and mutants with VEGFR2. From the simulations, we concluded that mutant R108Q was the most stabilizing mutant among all others whereas R82Q, C86Y, and R108W complexed with VEGFR2 were comparatively less stabilizing as compared to the wild type. This study provides insight into pathogenic nsSNPs that can affect VEGFA protein structure and function. These high-risk variants must be taken into consideration for genetic screening of patients suffering from RA.
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Affiliation(s)
- Iraj Ahmed
- Atta-Ur-Rehman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Peter John
- Faculty of Applied Biosciences, ASAB, NUST, Islamabad, Pakistan.
| | - Attya Bhatti
- Faculty of Applied Biosciences, ASAB, NUST, Islamabad, Pakistan
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Bashir K, Chaudhary A, Aslam M, Fatima I, Sarwar R. Polymorphic Analysis of Genes PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175) in Arthritis Patients in Pakistani Population. Biochem Genet 2023:10.1007/s10528-023-10513-7. [PMID: 37751115 DOI: 10.1007/s10528-023-10513-7] [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: 06/13/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
Genes are an important factor for the initiation of any disease. Many genes are associated with rheumatoid arthritis (RA) other than environmental factors. The main objective of the study was to evaluate the association of genes PADI4 (peptidylarginine deiminases 14) (rs2240340, rs1748033) and Human leukocyte antigen class II histocompatibility, D-related beta chain (HLA-DRB1) (rs2395175) polymorphisms in RA patients from Punjab, Pakistan. Blood samples of RA patients were collected from different hospitals of Sargodha. DNA was extracted, followed by PCR. Polymorphic analysis was performed in 300 rheumatoid arthritis patients and 300 healthy controls on PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175). In PADI4 gene, both homozygous mutant genotype (TT) and heterozygous (CT) of SNP rs2240340 showed significant association by increasing the risk of RA up to two fold (OR 2.55; 95% CI 1.57-4.15; p = 0.0002). In case of rs1748033 polymorphism, homozygous mutant genotype (TT) showed significant association with RA by increasing the risk of disease up to three fold (OR 3.46; 95% CI 1.97-6.07; p = 0.0001), while heterozygous genotype (CT) of the same SNP showed significant association with RA by playing a protective role (OR 0.57; 95% CI 0.36-0.91; p = 0.0197). In HLA-DRB1 gene, homozygous mutant genotype (GG) of SNP rs2395175 showed no significant association with RA, while heterozygous genotype (AG) of the same SNP showed significant association with RA by playing a protective role (OR 0.44; 95% CI 0.27-0.71; p = 0.0009). Highly significance association of genes PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175) polymorphisms with RA was observed in Pakistani population.
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Affiliation(s)
- Kashif Bashir
- Department of Zoology, Institute of Molecular Biology and Biotechnology, The University of Lahore, Sargodha Campus, Sargodha, Pakistan.
| | - Ayesha Chaudhary
- Department of Zoology, Institute of Molecular Biology and Biotechnology, The University of Lahore, Sargodha Campus, Sargodha, Pakistan
| | - Mehwish Aslam
- Department of Zoology, Institute of Molecular Biology and Biotechnology, The University of Lahore, Sargodha Campus, Sargodha, Pakistan
| | - Ishrat Fatima
- Department of Zoology, Institute of Molecular Biology and Biotechnology, The University of Lahore, Sargodha Campus, Sargodha, Pakistan
| | - Romana Sarwar
- Department of Microbiology and Molecular Biology, Women University Swabi, Swabi, Pakistan
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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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6
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Wagan AA, Chandio SA, Surahyo P. Premature Ejaculatory Dysfunction in Rheumatoid Arthritis (PED-RA Study). Pak J Med Sci 2022; 38:2131-2136. [PMID: 36415268 PMCID: PMC9676567 DOI: 10.12669/pjms.38.8.5698] [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: 11/17/2021] [Revised: 01/25/2022] [Accepted: 09/19/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE To determine the frequency of premature ejaculatory dysfunction in rheumatoid arthritis patients. METHODS After approval from IRB, cross sectional study was conducted from November 1st, 2020 to August 1st, 2021 at Department of Rheumatology, Indus Medical College, Pakistan. RA patients were included, written and informed consents were taken. Demographic data was noted and detailed history and examination was carried out. Each participant BMI and Blood pressure was measured. Afterward 5-ml of blood was drawn by a trained phlebotomist for CBC, ESR, fasting blood sugar levels, HBs Ag and anti HCV Antibody test.DAS-28 Calculator was used for RA clinical activity. Premature ejaculation diagnostic tool was used for the assessment of premature ejaculation. RESULTS Total 168 patients with mean age 32.27 (SD=±9.49) and mean disease duration of 6.35 (SD=±3.95) years were included,. Prevalence of premature ejaculation dysfunction was (44.6%), with mean PED of score 9.17 (SD=±5.23). Hypertension, HCV, Hakeem medications, use of DMARDS had positive association while High BMI and higher DAS-28 has negative association with PED (p<0.05). CONCLUSION There is high prevalence of PED in RA, it needs proper evaluation, treatment and urgent research is needed to know more about it.
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Affiliation(s)
- Abrar Ahmed Wagan
- Dr. Abrar Ahmed Wagan, MBBS, FCPS (Medicine), FCPS (Rheumatology), FACR. Associate Professor of Rheumatology, Indus Medical College, Tando Mohammad Khan
| | - Sultan Ahmed Chandio
- Dr. Sultan Ahmed Chandio, MBBS, FCPS (Medicine) Assistant Professor of Medicine SMBBMU, Larkana, Pakistan
| | - Paras Surahyo
- Dr. Paras Surahyo, MBBS, FCPS (Radiology) Senior Registrar, Bilawal Medical College, Jamshoro, Pakistan
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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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Cai Q, Pesa J, Wang R, Fu AZ. Depression and food insecurity among patients with rheumatoid arthritis in NHANES. BMC Rheumatol 2022; 6:6. [PMID: 35105369 PMCID: PMC8808967 DOI: 10.1186/s41927-021-00236-w] [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: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Social determinants of health (SDH), including food insecurity, are associated with depression in the general population. This study estimated the prevalence of depression and food insecurity and evaluated the impact of food insecurity and other SDH on depression in adults with rheumatoid arthritis (RA). Methods Adults (≥ 18 years) with RA were identified from the 2013–2014 and 2015–2016 National Health and Nutrition Examination Survey (NHANES). Depression was defined as a score of ≥ 5 (mild depression: 5–9; moderate-to-severe depression: 10–27) using the Patient Health Questionnaire-9 (PHQ-9). Food insecurity was assessed with the 18-item US Household Food Security Survey Module. Adults with household-level marginal-to-very-low food security were classified as experiencing food insecurity. The prevalence of depression and food insecurity among participants with RA were estimated. Weighted logistic regression was used to evaluate the association between depression and participants’ characteristics including SDH. Penalized regression was performed to select variables included in the final multivariable logistic regression. Results A total of 251 and 276 participants from the 2013–2014 and the 2015–2016 NHANES, respectively, had self-reported RA. The prevalence of depression among these participants was 37.1% in 2013–2014 and 44.1% in 2015–2016. The prevalence of food insecurity was 33.1% in 2013–2014 and 43.0% in 2015–2016. Food insecurity was associated with higher odds of having depression (OR 2.17, 95% CI 1.27, 3.72), and the association varied by depression severity. Compared with participants with full food security, the odds of having depression was particularly pronounced for those with very low food security (OR 2.96, 95% CI 1.48, 5.90) but was not significantly different for those with marginal or low food security. In the multivariable regression, being female, having fair/poor health condition, any physical disability, and ≥ 4 physical limitations were significantly associated with depression. Conclusions In adults with self-reported RA, the prevalence of depression and food insecurity remained high from 2013 to 2016. We found that depression was associated with SDH such as food insecurity, although the association was not statistically significant once adjusted for behavioral/lifestyle characteristics. These results warrant further investigation into the relationship between depression and SDH among patients with RA. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00236-w.
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Affiliation(s)
- Qian Cai
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA.
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Ruibin Wang
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA.,Harvard TH Chan School of Public Health, Cambridge, MA, USA
| | - Alex Z Fu
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA.,Georgetown University Medical Center, Washington, DC, USA
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Espinoza G, Maldonado G, Narvaez J, Guerrero R, Citera G, Rios C. Beyond Rheumatoid Arthritis Evaluation: What are We Missing? Open Access Rheumatol 2021; 13:45-55. [PMID: 33790666 PMCID: PMC8007602 DOI: 10.2147/oarrr.s298393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune systemic disease that preferentially affects small and large joints with a progressive course and can become deforming and disabling. In recent years, much progress has been made in the evaluation of inflammation and disease activity, however, there are other factors that have a high impact on the quality of life of these patients, such as depression, anxiety, fatigue, sleep disorders, suicidal behavior, fibromyalgia, sexual activity, sarcopenia, frailty, cachexia and obesity that are not always evaluated by rheumatologists. This review shows that the evaluation and timely detection of these aspects in patients with RA could interfere with the prognosis and improve their quality of life.
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Affiliation(s)
- Gianna Espinoza
- Rheumatology Department - Universidad Espiritu Santo, Samborondon, Ecuador
| | - Genessis Maldonado
- Internal Medicine Department - Loyola MacNeal Hospital, Berwyn, United States of America
| | - Jemina Narvaez
- Rheumatology Department - Universidad Espiritu Santo, Samborondon, Ecuador
| | - Roberto Guerrero
- Rheumatology Department - Universidad Espiritu Santo, Samborondon, Ecuador
| | - Gustavo Citera
- Rheumatology Department – Instituto Nacional de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Carlos Rios
- Rheumatology Department - Universidad Espiritu Santo, Samborondon, Ecuador
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Bay LT, Graugaard C, Nielsen DS, Möller S, Ellingsen T, Giraldi A. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020; 8:615-630. [PMID: 32912833 PMCID: PMC7691882 DOI: 10.1016/j.esxm.2020.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction An increased risk of sexual health problems is seen among patients with chronic illnesses. The background is likely to be multifactorial, but it remains poorly understood. Aim To investigate the sexual health and functioning of patients with rheumatoid arthritis (RA) and to examine gender differences, general population comparisons, and possible somatic, psychological, and disease-specific determinants. Methods A cross-sectional study using a digital questionnaire distributed among 380 patients diagnosed with RA in a Danish university hospital outpatient setting. Main Outcome Measure A range of patient-reported outcomes were obtained, including scores from the validated rating scale Changes in Sexual Functioning Questionnaire. Furthermore, individual medical record information was collected. Results A total of 329 patients (250 women and 79 men) were included (age range: 25–73 years; mean age: 57.2 years). The Changes in Sexual Functioning Questionnaire scoring indicated an overall sexual dysfunction in 33.8% of men and 58.1% of women.More than one-third (37.6%) of patients felt that RA had made their sex life more complicated, and 32.4% feared that this might someday be the case. In total, 29.2% patients had experienced sexual problems due to their RA treatment. Of the respondents who experienced RA-related fatigue, 46.5% reported that this impacted negatively on their sexual activity. The risk of one or more sexual health adversities was significantly correlated with female gender, older age, moderate or severe depression, moderate to moderately high loneliness, more than 2 comorbidities, and a fatigue score above 75 out of 100 on a visual analogue scale. Compared to the general population, significantly fewer patients with RA considered their sex life important, and significantly fewer patients appraised their current sex life as good or very good. Moreover, significantly more women with RA (32.1%) than women from the general population (15.7%) had not had any sex life during the past year. A vast majority of patients with RA (93.5% of women and 85.5% of men) had not discussed sexual issues with a health-care professional during the last 5 years. Of all, 32.5% would like health-care professionals to address sexual topics in the consultation occasionally. Conclusion Sexual dysfunction is highly prevalent in patients with RA, but the problems are not regularly addressed in consultations provided by the rheumatology department. Bay LT, Graugaard C, Nielsen DS, et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020;8:615–630.
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Affiliation(s)
- Laila Twisttmann Bay
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark.
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dorthe S Nielsen
- Department of Health Research, University College Lillebaelt, Odense, Denmark; Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Centre Copenhagen, Denmark & Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Lwin MN, Serhal L, Holroyd C, Edwards CJ. Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatol Ther 2020; 7:457-471. [PMID: 32535834 PMCID: PMC7410879 DOI: 10.1007/s40744-020-00217-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
Over 60% of rheumatoid arthritis (RA) patients achieve a good response after 12 months of treatment when following the European league against rheumatism (EULAR) guidelines for treatment. However, almost half of patients still suffer from moderate to severe disease activity despite this. In addition, mental health problems may remain despite reduced measures of inflammation systemically and within joints. Depression is two times more common in RA patients than in the general population, and intriguingly a bi-directional relationship with RA has been shown in cross-sectional studies. Chronic inflammation impairs the physiological responses to stress including effective coping behaviours, resulting in depression, which leads to a worse long-term outcome in RA. In RA patients, the pain score is not always solely related to inflammatory arthritis and immunological disease activity by Bąk et al. (Patient Prefer Adherence 13:223-231, [1]). Non-inflammatory pain secondary to anxiety, depression, sleep disturbance and the psychosocial situation needs to be considered whilst fibromyalgia, mechanical pain and neuropathic pain can also contribute to overall pain scores by Chancay et al. (Women's Midlife Health 5:3, [2]). Hence, the UK National Institute for Health and Care Excellence (NICE) guideline for the management of RA included psychological interventions for fatigue, low mood and social well-being (NICE NG100, 2018) [3], and the NICE clinical guidelines (CG91) [4] suggest managing mental health and depression in chronic medical conditions to improve treatment outcomes. This is a narrative review of the impact of mental health on RA disease activity in terms of patient-reported outcomes (PROs).
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Affiliation(s)
- May N Lwin
- University Hospital Southampton, Southampton, UK.
| | - Lina Serhal
- University Hospital Southampton, Southampton, UK
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12
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Trends in Opioid Use in a Cohort of Patients with Rheumatoid Arthritis. Pain Res Manag 2020; 2020:3891436. [PMID: 32724487 PMCID: PMC7382740 DOI: 10.1155/2020/3891436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022]
Abstract
The objective was to determine the trend in the use of opioid analgesics in a cohort of patients diagnosed with and treated for rheumatoid arthritis (RA) in 24 cities in Colombia. This retrospective cohort study included adult patients diagnosed with RA, which was managed in a specialized institution in Colombia between January 2011 and December 2012. The first rheumatology visit was recorded as an index date, and monthly monitoring of the analgesic medication received was performed until December 2017. Sociodemographic variables, the use of opioids, and concomitant prescriptions were evaluated. A total of 1,329 patients diagnosed with and treated for RA were included; they had a mean age of 61.2 ± 11.8 years and were predominantly females (n = 936; 82.9%). A total of 1,129 (84.9%) subjects used opioids for at least one month, and a growing trend, from 13.5% to 21.4%, was observed in patients who received opioids every month throughout a 7-year follow-up of the cohort. In total, 46.7% of the cases used opioids for more than 12 months. The most commonly used opioids were codeine (76.3%) and tramadol (71.1%). All patients received conventional disease-modifying antirheumatic drugs (DMARDs), 85.6% received systemic corticosteroids, 73.9% received nonsteroidal anti-inflammatory drugs, and 15.9% received biological DMARDs. A high proportion of opioid use was shown for pain management in patients with RA, in many cases for more than 12 months, in whom the efficacy and especially safety, related to the risk of dependence, should be monitored.
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13
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[Depressive symptoms in early rheumatoid arthritis : Within the rheumatism network ADAPTHERA]. Z Rheumatol 2019; 78:670-676. [PMID: 31016369 DOI: 10.1007/s00393-019-0596-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE For patients with established rheumatoid arthritis and also early arthritis an increased prevalence of depression has been described. For a better understanding of depression in early arthritis patients, depression prevalences of a German early arthritis cohort were examined, with a focus on disease activity, anti-CCP status, disease duration and functional capacity over a period of 2 years. MATERIAL AND METHODS The evaluation was based on the early arthritis cohort ADAPTHERA from Rhineland-Palatinate. The inclusion criterion was a symptom duration before diagnosis of a maximum of 1 year. Data from the disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ, functional status), the WHO-5 Well-Being Index (WHO-5, well-being and depressive symptoms) and the Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) were collected. RESULTS At the beginning, 43.5% of patients had depressive symptoms (WHO-5 > 28). After the 2 year follow-up the percentage of patients with depressive symptoms had reduced to 20.8%. Correlations with disease activity according to DAS28 and the function of HAQ could be confirmed. There was no correlation between depressive symptoms and anti-CCP status (p = 0.431) or duration from symptom onset to diagnosis (p = 0.671). CONCLUSION Screening of early arthritis patients for the presence of depressive symptoms is of essential importance. Patients seem to be at high risk of developing depressive symptoms especially at the beginning of the disease and when showing high disability and poor results on disease activity score (DAS28 and visual analog scale).
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Jamshidi T, Ghanei Gheshlagh R, Ebtekar F, Dalvand S, Vahedian Azimi A, Kurdi A. Prevalence of depression among Iranian patients with rheumatoid arthritis: a systematic review and meta-analysis. Open Access Rheumatol 2019; 11:53-59. [PMID: 30863193 PMCID: PMC6388731 DOI: 10.2147/oarrr.s191459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) are prone to depression due to several factors related to their RA, including chronic and persistent pain, functional disability, economic constraints, and the side effects of RA medication. Previous Iranian studies showed conflicting and inconclusive findings regarding the prevalence of depression among RA patients. Therefore, this systematic review and meta-analysis was conducted to estimate the true prevalence of depression in Iranian patients with RA. Search for eligible articles was performed using the keywords of depression, depressive disorder, dysthymic disorder, major depressive disorder, RA, and Iran, and their possible combinations in the following databases: Scientific Information Database, MagIran, Web of Science/ISI, PubMed, and Scopus. The search was restricted to articles published in Persian and English languages. The meta-analysis was performed using the random effects model, and the data were analyzed using the STATA software version 12. Overall, six articles were selected; the overall prevalence of depression among the Iranian patients with RA was 65.58% (95% CI: 56.53%-74.62%). There were no significant relationships between the prevalence of depression and articles' methodological quality and year of publication, participants' age, sample size, and duration of disease. More than half of RA patients suffer from depression. The overlap between the physical symptoms of RA and depression in this group of patients makes it difficult to correctly diagnose depression; therefore, initiative and efforts are required to improve the identification of early depression symptoms in RA patients in order to effectively manage their depression.
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Affiliation(s)
- Tayebeh Jamshidi
- Psychiatric Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Ghanei Gheshlagh
- Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran,
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran,
| | - Fariba Ebtekar
- Department of Midwifery, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahar Dalvand
- Department of epidemiology and Biostatistics, school of Public health, Tehran University of Medical sciences, Tehran, Iran
| | - Amir Vahedian Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
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Mohsin Z, Asghar AA, Faiq A, Khalid I, Ul-Haque I, Rehman S, Ahmed SI, Basalat ST, Aimen A, Shafique S, Hanif A, Iqbal MW, Samad SA, Siddiqui F, Hameed I, Safri M. Prevalence of Rheumatic Diseases in a Tertiary Care Hospital of Karachi. Cureus 2018; 10:e2858. [PMID: 30148011 PMCID: PMC6107035 DOI: 10.7759/cureus.2858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Rheumatic diseases are referred to as conditions affecting joints, muscles, ligaments, tendons, and bones. According to a report by World Health Organization, rheumatic and musculoskeletal diseases were labeled as the second most reported cause of disability around the globe. The purpose of this study was to estimate the prevalence of rheumatic diseases in a tertiary care hospital of Karachi; additionally, associations with age groups, gender and comorbidities were obtained as well. METHODS A cross-sectional study was conducted at the Orthopedic Out Patient Department (OPD) of Dr. Ruth KM Pfau Civil Hospital, Karachi over a span of three months in 2018 (February till May). All 346 patients were follow-up diagnosed cases in the age range of 11-90 years, divided into groups of adolescents, young adults, adults, and older adults. The subjects were questioned about their symptoms, duration of illness, presence of comorbidities, genetic background and the therapy they are undergoing along with compliance. Simple statistical analysis of frequency was done, whereas chi-square test was applied to study associations with gender, age groups, and comorbidities. RESULTS During the study period, a total of 2000 patients visited the orthopedic OPD, 346 of which were diagnosed cases of rheumatic diseases, yielding a prevalence of 17.3%. The mean age of rheumatic patients who partook in the study was 46.15 ± 15.49 (Range: 12 - 84). Osteoarthritis was recorded as the most prevalent condition, followed by non-specific low back pain and rheumatoid arthritis. Osteoarthritis was statistically significant in young adults, adults, and older adults, while non-specific low back pain had significant associations with gender, young adults, and adults. Diabetes was significantly associated with osteoarthritis, non-specific low back pain, shoulder pain syndrome and psoriatic arthritis, while hypertension significantly co-existed with systemic lupus erthematosus. CONCLUSION Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (18-40 years) within our setup.
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Affiliation(s)
- Zainab Mohsin
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Arifa A Asghar
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Arisha Faiq
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Ilma Khalid
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Ibtehaj Ul-Haque
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi , PAK
| | - Sameen Rehman
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Saffia I Ahmed
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Abeeha Aimen
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Shiza Shafique
- Dow University of Health Sciences, Civil Hospital, Karachi, PAK
| | - Ayesha Hanif
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
| | - Muhammad Waqas Iqbal
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
| | - Syed A Samad
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
| | - Faiza Siddiqui
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
| | - Ishaque Hameed
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
| | - Marzia Safri
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan, Karachi, PAK
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16
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Park SJ, Hong S, Jang H, Jang JW, Yuk B, Kim CE, Park S. The Prevalence of Chronic Physical Diseases Comorbid with Depression among Different Sex and Age Groups in South Korea: A Population-Based Study, 2007-2014. Psychiatry Investig 2018; 15:370-375. [PMID: 29669409 PMCID: PMC5912490 DOI: 10.30773/pi.2017.09.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/16/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE People with depression often suffer from comorbid, chronic physical diseases. Little is known about how demographic characteristics such as age and sex influence the prevalence of chronic physical diseases comorbid with depression. Therefore, this study aimed to explore the age and sex differences in the prevalence of diverse, chronic physical diseases comorbid with depression. METHODS This cross-sectional survey were conducted with the participants (n=45,598) of the Korean National Health and Nutrition Examination Survey (KNHANES). Using log-binomial regression, age adjusted prevalence ratios (APR) of chronic physical diseases of participants with depression and those without depression were estimated for each sex and age group. RESULTS The APR of most chronic physical diseases were significantly higher among respondents with depression than those without depression. Chronic physical diseases that showed the highest APR were asthma in adult male respondents (APR=3.46) and adult female respondents (APR=2.19) and chronic renal failure in elderly male respondents (APR=8.36) and elderly female respondents (APR=1.94). CONCLUSION Prevalence ratios of the chronic physical diseases comorbid with depression differed according to sex and age groups. Collaborative care strategies should be designed according to demographic characteristics of the population.
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Affiliation(s)
- Se Jin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Seungyeon Hong
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Hyesue Jang
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Jung Won Jang
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea.,Department of Health Sciences, Graduate School, Hanyang University, Seoul, Republic of Korea
| | - Boram Yuk
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Chul Eung Kim
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
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18
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Yrondi A, Aouizerate B, El-Hage W, Moliere F, Thalamas C, Delcourt N, Sporer M, Taib S, Schmitt L, Arlicot N, Meligne D, Sommet A, Salabert AS, Guillaume S, Courtet P, Galtier F, Mariano-Goulart D, Champfleur NMD, Bars EL, Desmidt T, Lemaire M, Camus V, Santiago-Ribeiro MJ, Cottier JP, Fernandez P, Meyer M, Dousset V, Doumy O, Delhaye D, Capuron L, Leboyer M, Haffen E, Péran P, Payoux P, Arbus C. Assessment of Translocator Protein Density, as Marker of Neuroinflammation, in Major Depressive Disorder: A Pilot, Multicenter, Comparative, Controlled, Brain PET Study (INFLADEP Study). Front Psychiatry 2018; 9:326. [PMID: 30087626 PMCID: PMC6066663 DOI: 10.3389/fpsyt.2018.00326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Major depressive disorder (MDD) is a serious public health problem with high lifetime prevalence (4.4-20%) in the general population. The monoamine hypothesis is the most widespread etiological theory of MDD. Also, recent scientific data has emphasized the importance of immuno-inflammatory pathways in the pathophysiology of MDD. The lack of data on the magnitude of brain neuroinflammation in MDD is the main limitation of this inflammatory hypothesis. Our team has previously demonstrated the relevance of [18F] DPA-714 as a neuroinflammation biomarker in humans. We formulated the following hypotheses for the current study: (i) Neuroinflammation in MDD can be measured by [18F] DPA-714; (ii) its levels are associated with clinical severity; (iii) it is accompanied by anatomical and functional alterations within the frontal-subcortical circuits; (iv) it is a marker of treatment resistance. Methods: Depressed patients will be recruited throughout 4 centers (Bordeaux, Montpellier, Tours, and Toulouse) of the French network from 13 expert centers for resistant depression. The patient population will be divided into 3 groups: (i) experimental group-patients with current MDD (n = 20), (ii) remitted depressed group-patients in remission but still being treated (n = 20); and, (iii) control group without any history of MDD (n = 20). The primary objective will be to compare PET data (i.e., distribution pattern of neuroinflammation) between the currently depressed group and the control group. Secondary objectives will be to: (i) compare neuroinflammation across groups (currently depressed group vs. remitted depressed group vs. control group); (ii) correlate neuroinflammation with clinical severity across groups; (iii) correlate neuroinflammation with MRI parameters for structural and functional integrity across groups; (iv) correlate neuroinflammation and peripheral markers of inflammation across groups. Discussion: This study will assess the effects of antidepressants on neuroinflammation as well as its role in the treatment response. It will contribute to clarify the putative relationships between neuroinflammation quantified by brain neuroimaging techniques and peripheral markers of inflammation. Lastly, it is expected to open innovative and promising therapeutic perspectives based on anti-inflammatory strategies for the management of treatment-resistant forms of MDD commonly seen in clinical practice. Clinical trial registration (reference: NCT03314155): https://www.clinicaltrials.gov/ct2/show/NCT03314155?term=neuroinflammation&cond=depression&cntry=FR&rank=1.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, UMR INRA 1286, NutriNeuro, Université de Bordeaux, Bordeaux, France
| | - Wissam El-Hage
- CHRU de Tours, Centre Expert Dépression Résistante FondaMental, Inserm U1253 iBrain, Inserm CIC 1415, Tours, France
| | - Fanny Moliere
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, Expert Center for Resistant Depression, Fondation Fondamental, Montpellier, France
| | - Claire Thalamas
- CIC 1436, Service de Pharmacologie Clinique, CHU de Toulouse, INSERM, Université de Toulouse, UPS, Toulouse, France
| | - Nicolas Delcourt
- Centre Anti Poison CHU Toulouse Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marie Sporer
- Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Nicolas Arlicot
- CHRU de Tours, Unité de Radiopharmacie, Tours, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,INSERM CIC 1415, University Hospital, Tours, France
| | - Deborah Meligne
- Institut des handicaps des Handicaps Neurologiques, Psychiatriques et Sensoriels, FHU HoPeS, CHU Toulouse, France
| | - Agnes Sommet
- CIC 1436, Service de Pharmacologie Clinique, CHU de Toulouse, INSERM, Université de Toulouse, UPS, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche Clinique (USMR), CHU de Toulouse, Toulouse, France
| | - Anne S Salabert
- Departement de Médecine Nucléaire, CHU Toulouse, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, Expert Center for Resistant Depression, Fondation Fondamental, Montpellier, France.,INSERM U1061, Université de Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, Expert Center for Resistant Depression, Fondation Fondamental, Montpellier, France.,INSERM U1061, Université de Montpellier, Montpellier, France
| | - Florence Galtier
- Centre Hospitalier Régional Universitaire Montpellier, Montpellier, France
| | - Denis Mariano-Goulart
- PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Département de Médecine Nucléaire, CHU de Montpellier, Montpellier, France
| | - Nicolas Menjot De Champfleur
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France.,Département d'Imagerie Médicale, Centre Hospitalier Universitaire Caremeau, Nîmes, France
| | - Emmanuelle Le Bars
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
| | - Thomas Desmidt
- CHRU de Tours, INSERM U1253, Université François Rabelais de Tours, Tours, France
| | - Mathieu Lemaire
- CHRU de Tours, INSERM U1253, Université François Rabelais de Tours, Tours, France
| | - Vincent Camus
- CHRU de Tours, INSERM U1253, Université François Rabelais de Tours, Tours, France
| | - Maria J Santiago-Ribeiro
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,INSERM CIC 1415, University Hospital, Tours, France.,Service de Médecine Nucléaire, CHRU Tours, Tours, France
| | - Jean P Cottier
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,Service de Neuro radiologie, CHRU Tours, Tours, France
| | - Philippe Fernandez
- Departement de Médecine Nucléaire, Hopital Pellegrin, Bordeaux, France.,Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR-5287), Université de Bordeaux, Bordeaux, France
| | - Marie Meyer
- Departement de Médecine Nucléaire, Hopital Pellegrin, Bordeaux, France.,Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR-5287), Université de Bordeaux, Bordeaux, France
| | - Vincent Dousset
- CHU Bordeaux Neurocentre Magendie, INSERM U1215, Université de Bordeaux, Bordeaux, France
| | - Olivier Doumy
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, UMR INRA 1286, NutriNeuro, Université de Bordeaux, Bordeaux, France
| | - Didier Delhaye
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
| | - Lucile Capuron
- INRA, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, University of Bordeaux, Bordeaux, France
| | - Marion Leboyer
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor-Albert Chenevier, AP-HP, Créteil, France.,INSERM U955, Translational Psychiatry, Paris-Est University, Créteil, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, Clinical Investigation Center 1431-INSERM, EA 481 Neurosciences, University of Bourgogne Franche-Comté, University Hospital of Besancon and FondaMental Foundation, Créteil, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Pierre Payoux
- Departement de Médecine Nucléaire, CHU Toulouse, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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Ji J, Zhang L, Zhang Q, Yin R, Fu T, Li L, Gu Z. Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis. Health Qual Life Outcomes 2017; 15:89. [PMID: 28464888 PMCID: PMC5414118 DOI: 10.1186/s12955-017-0659-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/19/2017] [Indexed: 01/29/2023] Open
Abstract
Background As an important outcome measure among rheumatoid arthritis (RA) patients, functional disability may contribute to unemployment, loss of work productivity, and impaired quality of life. However, little is known about the risk factors of functional disability in Chinese RA patients. This study aimed (1) to examine the prevalence of functional disability in Chinese RA patients; (2) to explore factors associated with the health assessment questionnaire-disability index (HAQ-DI). Methods A total of 101 RA patients in this cross-sectional study underwent standardized laboratory examinations and responded to the questionnaire for demographic data, the HAQ-DI for functional disability, the Compliance Questionnaire on Rheumatology (CQR) for medication adherence, the Hospital Anxiety and Depression Scale (HADS) for psychological status, and the Short Form 36 health survey (SF-36) for quality of life. Pain, grip/pinch strength, disease activity, and large joint mobility were recorded. Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze the data. Results The mean ± SD age of RA patients was 54.9 ± 11.9 years. Approximately 15.8% RA patients in mainland China experience functional disability (defined as a HAQ-DI score ≥ 1). Long disease duration, pain, high disease activity, a larger number of tender and swollen joints, high C-reactive protein (CRP) level, decreased grip strength, and limitation of shoulder, elbow, wrist, knee, and ankle motion were associated with the HAQ-DI. Participants with functional disability tended to have more severe depressive symptoms and a lower quality of life compared with individuals without functional disability. Stepwise logistic regression analyses found that limitation of wrist extension (P = 0.001) and lower body pain (BP) score (P = 0.001) explained higher HAQ-DI score. Conclusions The present study reported that functional disability was common in Chinese RA patients. A low quality of life and limitation of joint mobility had great impacts on functional disability in Chinese RA patients. Targeted and culturally sensitive interventions should be strengthened to delay the onset of disabilities of this population.
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Affiliation(s)
- Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Lijuan Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Qiuxiang Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Rulan Yin
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Ting Fu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Liren Li
- School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China.
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
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20
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Tang AC, Kim H, Crawford B, Ishii T, Treuer T. The Use of patient Reported Outcome Measures for Rheumatoid Arthritis in Japan: A Systematic Literature Review. Open Rheumatol J 2017; 11:43-52. [PMID: 28553419 PMCID: PMC5427692 DOI: 10.2174/1874312901711010043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background: Patient-reported outcomes (PRO) obtained through routine medical care may identify patients’ day-to-day burden and help tackle the disease from the patients’ perspective. However, there is a paucity of information regarding the availability of PRO data and PRO tools for rheumatoid arthritis (RA) in Japan. Objective: We reviewed the literature on PRO data availability and to identify PRO measures implemented in Japan for RA patients. Method: We conducted a systematic literature review using ICHUSHI and the PubMed databases on PRO measures for RA published from January 2011 to August 2015 in Japan. Results: After removing duplicates, 2423 manuscripts were found. From these, 100 manuscripts were included for review and analysis. We found 29 PRO tools that were used to assess various domains of health such as general well-being, pain, functionality, and fatigue. More than 90% of the studies utilized PRO tools for research purpose. Only one study reported PRO tool implementation in the routine medical care. Conclusion: The importance of PROs is recognized in Japan. PRO tools varied significantly and were mostly used for research purposes, while reports on the use of PRO measures in routine medical care were limited. Despite the awareness of PROs in the research community, unmet needs remain among RA patients in Japan. Further work is needed to investigate ways in which PROs can better reflect these unmet needs and be utilized in routine medical care.
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Affiliation(s)
- Ann Chuo Tang
- Akasaka Garden City, 4-15-1 Akasaka, Minato-ku, Tokyo, 107-0052 Japan
| | - Hyunchung Kim
- IMS Japan K.K., Toranomon Tower Office, 4-1-28 Toranomon, Minato-ku, Toyko, 105-0001 Japan
| | - Bruce Crawford
- IMS Japan K.K., Toranomon Tower Office, 4-1-28 Toranomon, Minato-ku, Toyko, 105-0001 Japan
| | - Taeko Ishii
- Akasaka Garden City, 4-15-1 Akasaka, Minato-ku, Tokyo, 107-0052 Japan
| | - Tamas Treuer
- Eli Lilly & Company Hungary. Lilly Hungária Kft. 1075 Budapest, Madách u. 13-14. (VII. emelet). Hungary
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21
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Masood A, Salim B, Nasim A, Khalid Z, Afzal A. Are we missing the diagnosis of depression in patients with rheumatoid arthritis at a tertiary care facility? Pak J Med Sci 2017; 33:300-305. [PMID: 28523026 PMCID: PMC5432693 DOI: 10.12669/pjms.332.11856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To determine if we are missing clinical depression in patients with Rheumatoid Arthritis and its relationship with functional disability and level of formal education in such patients. Methods: The data for this cross-sectional, analytical study was gathered from May 2015 till December 2015 and comprised of 128 with Rheumatoid arthritis diagnosed according to ACR/EULAR 2010 criteria. The study was conducted at Fauji Foundation Hospital Rawalpindi. Functional status was assessed with Modified Health Assessment Questionnaire (mHAQ) and Beck’s Depression Inventory (BDI) was used for evaluation of symptoms of depression. The relation between depression, functional disability and educational status was established using Pearson correlation coefficient. Results: The study included 128 patients with no previous diagnosis of depression. 122 (95.3%) were females and 6 (4.7%) were males. The mean age was 51.75 ± 9.25 years. Mean duration of disease was 8.95 ± 7.1 years. According to this study, the diagnosis of clinical depression was missed in 47.7% of patients with Rheumatoid Arthritis who had been under regular follow up at a tertiary care facility. About 18% were keen to seek professional help for depressive symptoms while 62.6% had functional disability (mild – severe). There is a positive correlation with BDI (Pearson’s correlation +1) and functional disability. No correlation could be established between level of education and depression as out of 79 (61.7%) patients with no basic education, 45.5% had depression. In remaining 49 (38.2%) patients, with some formal education, 51.3% had clinical depression. Conclusion: Almost half of the patients with Rheumatoid Arthritis coming to a tertiary care set up had clinical depression but were never diagnosed or referred to a Psychiatrist. There is a positive correlation between depression and functional disability; however no statistically significant correlation could be established with the level of formal education. The study further emphasizes the importance of early recognition and swift referral of such patients to a psychiatrist since it is known to improve both treatment outcomes and functional status.
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Affiliation(s)
- Ammara Masood
- Dr. Ammara Masood, MRCP, SCE (Rheumatology). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Babur Salim
- Dr. Babur Salim, FCPS(Med), FCPS (Rheumatology). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amjad Nasim
- Dr. Amjad Nasim, FCPS (Med). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Ziaullah Khalid
- Dr. Ziaullah Khalid, MBBS. Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amir Afzal
- Amir Afzal, Statistician. Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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22
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Zhang L, Xia Y, Zhang Q, Fu T, Yin R, Guo G, Li L, Gu Z. The correlations of socioeconomic status, disease activity, quality of life, and depression/anxiety in Chinese patients with rheumatoid arthritis. PSYCHOL HEALTH MED 2016; 22:28-36. [PMID: 27367831 DOI: 10.1080/13548506.2016.1198817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ2 analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.
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Affiliation(s)
- Lijuan Zhang
- a School of Nursing , Nantong University , Nantong , China.,b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Yunfei Xia
- b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Qiuxiang Zhang
- a School of Nursing , Nantong University , Nantong , China.,b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Ting Fu
- a School of Nursing , Nantong University , Nantong , China.,b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Rulan Yin
- a School of Nursing , Nantong University , Nantong , China.,b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Genkai Guo
- b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
| | - Liren Li
- a School of Nursing , Nantong University , Nantong , China
| | - Zhifeng Gu
- b Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
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23
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Zamora-Legoff JA, Achenbach SJ, Crowson CS, Krause ML, Davis JM, Matteson EL. Opioid use in patients with rheumatoid arthritis 2005-2014: a population-based comparative study. Clin Rheumatol 2016; 35:1137-44. [PMID: 27022929 PMCID: PMC4850553 DOI: 10.1007/s10067-016-3239-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 01/03/2023]
Abstract
Opioid prescriptions have seen an increase across the USA, Canada, Europe, and the UK. In the USA, they have quadrupled from 1999 to 2010. Opioid use among patients with rheumatoid arthritis (RA) over time is not well described. This study examined trends of opioid use in patients with RA. Retrospective prescription data was examined from 2005 to 2014 in a population-based incidence cohort of patients with RA by 1987 ACR criteria and comparable non-RA subjects. Differences in opioid use were examined with Poisson models. A total of 501 patients with RA (71 % female) and 532 non-RA subjects (70 % female) were included in the study. Total and chronic opioid use in 2014 was substantial in both cohorts 40 % RA vs 24 % non-RA and 12 % RA vs. 4 % non-RA, respectively. Opioid use increased by 19 % per year in both cohorts during the study period (95 % confidence interval [CI] 1.15, 1.25). Relative risk (RR) of chronic opiate use for RA patients compared to non-RA subjects was highest in adults aged 50-64 years (RR 2.82; 95 % CI 1.43-6.23). RA disease characteristics, biologic use at index, treated depression/fibromyalgia, education, and smoking status were not significantly associated with chronic opiate use. Over a third of patients with RA use opioids in some form, and in more than a tenth use is chronic. Use has increased in recent years. Patients aged 50-64 with RA use substantially more opioids than their non-RA counterparts.
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Affiliation(s)
| | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Megan L Krause
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John M Davis
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, USA.
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24
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Ryu E, Chamberlain AM, Pendegraft RS, Petterson TM, Bobo WV, Pathak J. Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records. BMC Psychiatry 2016; 16:114. [PMID: 27112538 PMCID: PMC4845377 DOI: 10.1186/s12888-016-0821-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/18/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is often comorbid with other chronic mental and physical health conditions. Although the literature widely acknowledges the association of many chronic conditions with the risk of MDD, the relative importance of these conditions on MDD risk in the presence of other conditions is not well investigated. In this study, we aimed to quantify the relative contribution of selected chronic conditions to identify the conditions most influential to MDD risk in adults and identify differences by age. METHODS This study used electronic health record (EHR) data on patients empanelled with primary care at Mayo Clinic in June 2013. A validated EHR-based algorithm was applied to identify newly diagnosed MDD patients between 2000 and 2013. Non-MDD controls were matched 1:1 to MDD cases on birth year (±2 years), sex, and outpatient clinic visits in the same year of MDD case diagnosis. Twenty-four chronic conditions defined by Chronic Conditions Data Warehouse were ascertained in both cases and controls using diagnosis codes within 5 years of index dates (diagnosis dates for cases, and the first clinic visit dates for matched controls). For each age group (45 years or younger, between 46 and 60, and over 60 years), conditional logistic regression models were used to test the association between each condition and subsequent MDD risk, adjusting for educational attainment and obesity. The relative influence of these conditions on the risk of MDD was quantified using gradient boosting machine models. RESULTS A total of 11,375 incident MDD cases were identified between 2000 and 2013. Most chronic conditions (except for eye conditions) were associated with risk of MDD, with different association patterns observed depending on age. Among 24 chronic conditions, the greatest relative contribution was observed for diabetes mellitus for subjects aged ≤ 60 years and rheumatoid arthritis/osteoarthritis for those over 60 years. CONCLUSIONS Our results suggest that specific chronic conditions such as diabetes mellitus and rheumatoid arthritis/osteoarthritis may have greater influence than others on the risk of MDD.
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Affiliation(s)
- Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | | | | | | | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, NY, USA.
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