Depression and pain in patients with rheumatoid arthritis: Mediating role of illness perception (original) (raw)
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Depression, inflammation, and pain in patients with rheumatoid arthritis
Arthritis & Rheumatism, 2009
Objective. An association between depression and inflammation has been suggested. In patients with rheumatoid arthritis (RA), pain is a major symptom associated with depression and inflammation. We examined the independent associations between depression, the inflammation marker C-reactive protein (CRP) level, and pain in patients with RA. Methods. In total, 218 RA outpatients completed self-administered questionnaires, using the Beck Depression Inventory II to measure depressive symptoms and a visual analog scale to quantify their perceived pain. Functional disability and CRP level were also measured. Results. Depression scores were mildly and positively correlated with the CRP level (r ؍ 0.46, P < 0.001). Both the depression score (standardized  ؍ 0.35, P < 0.001) and the CRP level (standardized  ؍ 0.35, P < 0.001) were significantly associated with pain, even after adjustment for clinical covariates in regression analysis. In logistic analysis, the combined effects on the risk of severe pain (pain score in the upper tertile) increased with depression scores and CRP levels linearly. Conclusion. Depression severity and inflammation were associated with each other and appeared to have independent effects on perceived pain. Therefore, a clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control.
Depression History, Stress, and Pain in Rheumatoid Arthritis Patients
Journal of Behavioral Medicine, 2007
This study examined the role of past episodes of depression on pain reports for patients with rheumatoid arthritis (RA) before and during stress induction. A history of major depressive episodes was assessed by diagnostic interviews for 138 RA patients, 74 who later participated in a set of laboratory procedures designed to induce interpersonal stress. Patients were evaluated by a rheumatologist and then asked to report joint and bodily pain throughout the laboratory study. We found that RA patients with a history of two or more episodes of major depression had more pain at baseline, and exhibited higher pain in response to the stress induction than did RA patients with either only one episode or no history of depression. Such findings provide new insight in the dynamic relationships between depression, stress, and pain.
Acta Scientiarum. Health Science, 2023
This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treatment with disease-modifying antirheumatic drugs (DMARD), for at least one year, and evaluated by pain intensity numeric scale and by the McGill Pain Questionnaire (MPQ), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). We compared them with 46 patients without RA matched by age and sex. We also examined the relationships between anxiety and depression and pain intensity, disease activity and physical dysfunction accessed by the Rheumatoid Arthritis Disease Activity Index (RADAI) and the Health Assessment Questionnaire (HAQ), respectively. Most patients with RA, 93.5%, continued to report joint pain and had higher pain intensity and higher scores in all domains of the McGill Pain Questionnaire (MPQ) than 58.7% of the 46patients without RA with joint pain. Patients with RA were more likely to have depression defined by HADS≥11 than the controls but the association was non-significant when adjusted for the presence of pain. The median score of anxiety symptoms was significantly higher in patients with RA than in those without RA. There was an association of depression and a positive significant correlation of anxiety symptoms with higher intensity of pain, disease activity and physical dysfunction. There was no difference between patients with RA and depression and without depression on the sensory domain and in the total MPQ score. Otherwise, there was a moderate significant correlation of the levels of anxiety with all pain domains of the MPQ, except the sensory one. In conclusion, pain remains a prevalent symptom in RA patients despite treatment. More studies are necessary to verify if the qualitative assessment of pain could be used to evaluate the influence of anxiety and depression on pain reported by these patients.
Depression in rheumatoid arthritis: A re-evaluation
Rehabilitation Psychology, 1991
Diagnosing mood disorders in chronic illness is problematic. Understanding the value of individual symptoms in predicting depression is one approach to this problem. The contribution of individual symptoms to the diagnoses of major depressive disorder (MDD) was examined in 82 patients with confirmed rheumatoid arthritis (RA) and a control sample of ISO university employees. Comparisons between DSM-HI and DSM-EQ-R rates of MDD were derived using the Inventory to Diagnose Depression (IDD). It was found that cognitive-affective symptoms such as dysphoric mood, acknowledgment of guilt, and suicidal ideation were the most efficient predictors of MDD. According to DSM-IH-R criteria, 16% of the RA sample met criteria for diagnosis of MDD, while 27% of the R A sample met criteria according to the DSM-1H. RA patients reported that their arthritis affected their mood at least occasionally.
Rheumatology, 1997
In this longitudinal study (12 and 24 months follow-up) of 216 patients with early rheumatoid arthritis (RA) (i4 yr duration), we assessed the strength and stability of the relationship between psychological distress and traditional clinical variables, examined the ability of these clinical variables to predict changes in mental distress, and explored the directionality between mental distress and the other clinical variables. Study variables were symptoms of anxiety and depression measured by the Arthritis Impact Measurement Scales, tender joint counts, erythrocyte sedimentation rate (ESR), and self-reported pain and disability. Psychological distress showed high levels of stability over time. Pain and disability were the two variables most strongly and consistently related to mental distress. High levels of disability predicted an increase in depression during the next year; otherwise, changes in psychological distress were not predicted by disease-related variables. Attempts at causal modelling of the temporal relationship between mental distress, pain and disability failed to yield consistent results.
1998
Objective. To determine whether a previous episode of major depression leaves a “scar” that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability. Methods. A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression. Results.
Symptoms of Depression and Disability among Rheumatoid Arthritis Patients
2020
Background Rheumatoid arthritis (RA) is a significant and serious public illness affecting peoples especially adults all over the world and emotional problems such as depressive symptoms are more common in patients with RA than in general population. Synovial inflammation, joint damage, degeneration of cartilage, bony destruction and limitation of physical functioning are the distinctive feature of RA that consequently leads to functional disability. This study aimed at assesses prevalence of symptoms of depression and disability among RA patients. Research Design: A descriptive correlational research design was utilized in this study. Study subjects: Established diagnosed 80 RA patients were included in the study. Two tools were used; Beck Depression Inventory (BDI) version I to assess symptoms of depression, and Health assessment questionnaire-disability index (HAQ-DI) to assess disease-related disability. Result: Majority of the participants were females with the age of (20-65) y...
Annals of the Rheumatic Diseases, 2007
Objective: To examine rheumatoid arthritis (RA) with short disease duration over 10 years, and to identify factors that are associated with the course of pain, depression and anxiety. Methods: A cohort of 238 patients with RA (age 20-70 years, mean disease duration 2.3 years, 68% rheumatoid factor positive) was followed with assessments at baseline and after 1, 2, 5 and 10 years. Selfreported health status was assessed by pain on a 100 mm visual analogue scale, the Arthritis Impact Measurement Scales (AIMS), the 28-item version of General Health Questionnaires, and the Health Assessment Questionnaire. We also examined the erythrocyte sedimentation ratio, grip strength (kg) and radiographic progression of the hands (van der Heijde modified Sharp score). Repeated measures analyses of variance were used to explore the effect of time on measures of outcome among completers, whereas repeated measures analyses using a mixed model were applied to identify factors that were longitudinally associated with pain, depression and anxiety. Results: At the various assessment points 30% had a visual analogue scale pain score of >40 mm, 5-13% had an AIMS depression score of >4.0 and 20-30% had an AIMS anxiety score of >4.0. The perceived level of pain was explained longitudinally by anxiety, disease activity, physical function and female gender, depression by high disease activity and anxiety, whereas anxiety was explained by low disease activity and depression. Conclusion: More patients had increased levels of anxiety (20-30%) than increased levels of depression (5-13%). Several factors, including anxiety, but not depression, were associated with the course of pain.
Depressive Symptoms andMomentary Mood Predict Momentary Pain Among Rheumatoid Arthritis Patients
2015
Background Although a relationship between mood and pain has been established cross-sectionally, little research has examined this relationship using momentary within-person data. Purpose We examined whether baseline depressive symptoms and within-person levels of negative and positive mood predicted momentary pain among 31 individuals with rheumatoid arthritis (RA). Methods Depressive symptomatology was measured at baseline. Mood and RA symptoms were self-reported via ecological momentary assessment five times a day for seven consecutive days. Analyses controlled for gender, age, weekend day, time of day, and experiences of stress. Results Greater momentary positive mood was associated with less momentary pain and fewer arthritis-related restrictions; negative mood was associated with more restrictions. Greater depressive symptomatology also predicted more pain and restrictions, an effect which was not accounted for by mood. Conclusions Results suggest that both depression and mood...