RA Increases Incidence of Depression in Patients, while Depressed Spouses can Worsen Disease Outcomes for Patients

Patients with rheumatoid arthritis (RA) are likely to suffer from depression, which can, in turn, increase levels of pain associated with the disease, new research at Nagoya City University and its Graduate Schools of Medicine in Japan found.

Led by Masayo Kojima, MD, PhD, the research team at Nagoya examined the link between depression, C-reactive protein level (CRP), and pain in 218 RA patients. The team saw “a significant positive association between depressive symptoms and CRP level in RA.” The patients with higher CRP levels suffered from higher rates of inflammation, which worsened RA symptoms and levels of pain. The higher levels of inflammation, in addition to increased depressive symptoms, “predicted severe pain even more strongly.”

According to Kojima, the results of the study are evidence that physicians who treat RA may need to pay more attention to the psychological effects of RA in addition to the physical ones.

"Results of our research demonstrate the potential for clinicians to improve pain control by addressing their patients' psychological symptoms in addition to conducting anti-inflammation therapy," said Dr. Kojima, who added that the study indicated, in patients reporting severe pain without CRP level elevation, psychotherapy and/or psychotropic medication might have priority. "A clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control.”

In a related study, researchers at the University of British Columbia (UBC) found that patients with RA who have spouses suffering from depression are more likely to experience worse disease outcomes.

Anita DeLongis, PhD, and her fellow researchers at UBC had 133 married RA patients fill out a number of questionnaires, including the Rheumatoid Arthritis Disease Activity Index and the Disabilities of the Arm, Shoulder, and Hand, assessing RA disease activity and disability at two time points one year apart. The patients and their spouses also filled out the Center for Epidemiologic Studies Depression Scale. All questionnaires were administered “at two time points one year apart.”

The researchers discovered that patients experienced a worse disease course over one year when they had spouses with higher levels of depression.

"Our findings highlight the key role played by the spouse in disease course of individuals with RA, and point to the importance of including the spouse in clinical interventions," concluded the UBC researchers. "The mood and mental health of the marital partner or other key members of the family may be critically important to consider in developing more effective and evidence-based treatment for RA patients.”

Results of the Nagoya and UBC studies were both published in Arthritis Care and Research.