Depression and severity of articular destruction in patients with rheumatoid arthritis

Aim. To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA). Materials and methods. 128 RA-patients were included, 87% were women with a mean age of 47.4 +/- 11.3 years and a median of RA duration 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue - with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSSi4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 - cDMARDs (n=39), 2 - cDMARDs+PPT (sertraline or mianserine), n=43, 3 - cDMARDs+bDMARDs (n=32), 4 - cDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants - from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction. Results. According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPlmax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only. Conclusion. Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.