Depression in Rheumatoid Arthritis: Association with Quality of Life, Function and Disease Activity

Abstract

Objectives: The aim of our study is to evaluate the depression rate in patients with rheumatoid arthritis (RA) and its association with pain, disease activity, functional status, and various health related quality of life (HRQoL) domains in terms of functional status, vitality, social and emotional functioning.

Materials and Methods: A total of 90 RA patients and 50 sex and age matched controls were included in the study. Demographic characteristics, erythrocyte sedimentation rates, C‐reactive protein, tender and swollen joint count, patient and physician global assessment of disease activity were recorded. Disease Activity Score‐28 (DAS28) was used for measuring disease activity. The severity of pain was determined by using 10 cm Visual Analog Scale‐Pain (VAS‐pain). HRQoL was evaluated by using Short Form 36 (SF 36). HAQ (Health Assessment Questionnaire) was used for evaluation of the functional status. Depression was evaluated by using Beck Depression Scale (BDS).

Results: Mean age was 54.51±12.54 in RA (75 women, 15 men) group and 51.94±9.69 in the control group (41 women, 9 men). Mean VAS‐pain was 55.85±26.24; HAQ was 1.27±0.81 and DAS28 was 5.04 ±2.44 in RA patients. The mean BDS was 19.67±13.11 in RA group and 6.64±6.73 in the control group. RA patients scored significantly higher in BDS when compared with the controls (p<0.001). BDS was linearly related with DAS28 and VAS‐pain at a high level and negatively correlated with physical function, physical role, bodily pain, general health, vitality, mental health, social functioning and emotional role subgroups of SF36 (p<0.001). There was no statistically significant relation between BDS and HAQ (p=0.431)

Conclusion: Depression is common in the patients with RA and associated with disease activity and pain. It negatively affects HRQoL in terms of vitality, and physical, social and emotional functioning.

Keywords

• Arthritis,rheumatoid,depression,quality of life

Romatoid Artritte Depresyon: Yaşam Kalitesi, Fonksiyon ve Hastalık Aktivitesi ile İlişkisi

Öz

Amaç: Çalışmamızın amacı romatoid artritli (RA) hastalarda ağrı, hastalık aktivitesi, fonksiyonel durum ve vitalite, fonksiyonellik, sosyal ve duygusal işlevsellik gibi sağlıkla ilişkili yaşam kalitesi (HRQoL) alanları arasındaki ilişkiyi değerlendirmektir.

Materyal ve Metot: Çalışmaya toplam 90 RA hastası ve 50 cinsiyet ve yaş uyumlu kontrol dahil edildi. Demografik özellikler, eritrosit sedimantasyon oranları, C‐reaktif protein, hassas ve şiş eklem sayısı, hasta ve hekimin global değerlendirmesi kaydedildi. Hastalık aktivitesini ölçmek için Hastalık Aktivite Skoru‐28 (DAS28) kullanıldı. Ağrının şiddeti, 10 cm Görsel Analog Skala‐Ağrı (VAS‐ağrı) kullanılarak belirlendi. HRQoL, Kısa Form 36 (SF 36) kullanılarak değerlendirildi. Fonksiyonel durumun değerlendirilmesi için HAQ (Sağlık Değerlendirme Anketi) kullanıldı. Depresyon, Beck Depresyon Ölçeği (BDS) kullanılarak değerlendirildi.

Bulgular: Yaş ortalaması RA'da (54 kadın, 15 erkek) 54,51 ± 12,54; kontrol grubunda (41 kadın, 9 erkek) 51,94 ± 9,69 idi. RA'lı hastalarda ortalama VAS 55,85 ± 26,24 idi; HAQ 1,27 ± 0,81, DAS28 ise 5,04 ± 2,44 idi. RA grubunda ortalama BDS 19,67 ± 13,11 ve kontrol grubunda 6,64 ± 6,73 idi. RA hastalar kontrol grubu ile karşılaştırıldığında, BDS'de anlamlı olarak daha yüksek puan aldı (p <0,001). BDS ile DAS28 ve VAS‐ağrı arasında doğrusal ilişki vardı ve SF36'nın fiziksel işlev, fiziksel rol, vücut ağrısı, genel sağlık, vitalite, zihinsel sağlık, sosyal işlevsellik ve duygusal rol alt grupları ile negatif korelasyon gösterdi (p <0,001). BDS ve HAQ arasında istatistiksel olarak anlamlı bir ilişki bulunmadı (p=0,431).

Sonuç: RA'lı hastalarda depresyon yaygındır ve hastalık aktivitesi ve ağrı ile ilişkilidir. Depresyon, vitalite fiziksel, sosyal ve duygusal işlevler açısından HRQoL'yi olumsuz yönde etkilemektedir.

Anahtar Kelimeler

• Artrit,romatoid,depresyon,yaşam kalitesi

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