Rheumatoid Arthritis Harder to Battle with Depressive Symptoms

Depression can lead to slower healing in rheumatoid arthritis (RA) patients, according to findings published in Arthritis Care & Research on November 10, 2014.

Researchers from the University of Maryland School of Medicine identified RA patients with and without depressive symptoms using single item questionnaires and recruited them from an existing registry sample in order to determine if prevalent and incident depressive symptoms influenced longitudinal changes in RA disease activity. Patients with and without prevalent and incident symptoms of depression were monitored for 2 years.

The researchers noted significant disease activity changes in patients with a lifetime prevalence of depressive symptoms, but not incident depressive symptoms, when compared to their counterparts who did not display any depressive symptoms. About 4,000 participants were recruited who displayed depressive symptoms and were then matched with non depressed controls. Prior depressive symptoms were associated with slower rates of RA disease activity decline, the researchers also found. The clinical disease activity index (CDAI) changes were estimated at 1 year past baseline to be -3.0 and -4.0 in patients with and without a lifetime prevalence, respectively. There were no effects on the timeline of prevalent symptoms of depression on swollen joints and acute phase reactants, the researchers acknowledged.

“Depressive symptoms temporally influence the evolution of RA disease activity, and the magnitude is dependent on the time of symptomatic onset,” the authors concluded. “However, the effect is limited to patient-reported pain, global assessment, and function; and physician-reported global assessment and tender joints.”

The researchers noted there is a cyclical link between depression and RA — could it be that depression slows the process of RA symptom improvement? Or that RA symptoms contribute to the symptoms of depression?

“Collectively, these data indicated that a prior history of depressive symptoms could affect how patients interpret and perceive their condition, or alternatively, that depression has an impact on the experience of musculoskeletal pain,” study leader Alan Rathbun, PhD, explained in Healthline.