07/09/09 A new study suggests that people with rheumatoid arthritis (RA) also frequently suffer from psychiatric disorders, most commonly depression.
The association between depression and rheumatoid arthritis has long been noted, but it is not clear whether people become depressed from the stress of struggling with the pain and disability of a chronic illness or whether the depression may be part of the autoimmune disease process itself.
“Our concept is that depression and RA are the two sides of the same process,” says Dr. Tatiana Lisitsyna, PhD, is a rheumatologist and senior scientific researcher at the Russian Academy of Medical Sciences in Moscow, who was the lead author of the study. “By our opinion, the depression often is already there before the RA onset or develops with RA symptoms at the same time and worsens because of the influence of additional chronic stress factors of RA.”
Dr. Lisitsyna and her team evaluated 75 people with rheumatoid arthritis, 96 percent of whom were female with a median age of 52, meaning that half the participants were younger and half were older.
Seventy-four percent had moderate to severe pain and the median length they had rheumatoid arthritis was 12 years.
They found that 63 percent of study participants suffered from a diagnosable psychiatric disorder, and it was usually depression.
The study also found that 33 percent of study participants had sleep disorders and 23 percent had cognitive dysfunction, 16 percent of which were attributed to depression. X-rays also showed patients with depression had more severe rheumatoid arthritis, but usually received less aggressive treatment.
The results were presented in June at the Annual Congress of the European League against Rheumatism, or EULAR, in Copenhagen, Denmark.
Christopher Edwards, PhD is the Director of the Chronic Pain Program at Duke University Medical Center in Durham, N.C. He says the information coming out of this study is likely new for the public, but is well known to physicians who work with patients suffering from chronic pain.
“For those of us who work with chronic pain daily, we are alarmed by the high number of patients who share depression and rheumatoid arthritis. But in patients with a range of chronic pain disorders, we recognize the study confirms what we already knew to be the case,” he says.
Edwards says it’s less important whether depression causes rheumatoid arthritis or rheumatoid arthritis causes depression because the bottom line remains the same.
“What we know is that suffering from one tends to correlate with suffering from another. So whether they cause one another is less important than that they exist together and should be treated together,” he explains. “It doesn’t matter if they’re causal because what I’m going to do for you when you walk through my office is not going to change if I know one causes another. I know I need to be aggressive in dealing with your pain and distress.”
Dr. Lisitsyna says these results show the importance of evaluating and addressing the mental health of rheumatoid arthritis patients and stress the need for that to be a regular part of any rheumatology practice.
“We think that doctors, especially rheumatologists and general practitioners who treat RA patients, should pay more attention to patients’ mood and connect RA patients with psychiatrists for timely diagnosis and treatment of depressive spectrum disorders,” she says.
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